HER2 Support Group Forums - View Single Post - Kadcydla versus neurosurgery and paralysis

schoonder · 09-20-2014, 05:46 PM

I don't know if Kadcyla crosses the blood-brain barrier, but at ESMO Conference, later this month the following abstract will be discussed.

"Abstract
Aim

Local treatment options such as radiotherapy or neurosurgery are the mainstay of brain metastases (BM) management. Whole brain radiotherapy (WBRT), however, is associated with severe late-toxicity. The LANDSCAPE trial established lapatinib plus capecitabine (LapCap) as primary systemic treatment in oligosymptomatic patients (pts) with multiple Her2-positive BM. Limited evidence exists regarding the activity of antibodies in BM. T-DM1 is an antibody-drug conjugate covalently linking trastuzumab (T) to an anti-microtubule agent (emtansine) with higher activity and lower toxicity as compared to LapCap. Therefore, we evaluated the activity of T-DM1 in newly diagnosed BM or BM progressing after local initial treatment.

Methods

Nine pts (median age 55 years) with Her2-positive BM treated at two Austrian centres were included. All pts had received prior treatment with T, five pts (55.6%) had already received lapatinib, and two pts (22.2%) pertuzumab as well. In two asymptomatic pts, T-DM1 was administered as primary therapy, while seven pts had documented CNS progression upon prior local treatment. T-DM1 was administered every three weeks at a dose of 3.6 mg/kg.

Results

Median follow-up was 6 months and median brain metastases-free survival 11 months. Seven pts (two with primary treatment and five receiving T-DM1 upon CNS progression) are currently assessable for CNS response. 3/7 pts (42.9%) had a partial remission, one patient progressing upon prior local therapy had stable disease lasting for fifteen cycles, and one patient had stable disease for 5 month. Two pts with prior WBRT had CNS progression after three treatment cycles.

Conclusions

This prospective case series again indicates relevant clinical activity of systemic treatment in Her2-positive BM. LapCap remains the standard of care but results of this analysis warrants further investigation of T-DM1 in BM in the context of prospective clinical studies.

Disclosure

R. Bartsch: has received lecture honoraria, research grants and travel support from Roche Austria. R. Bartsch has received lecture honoraria from GSK Austria; M. Preusser: has received lecture honoraria and research support from Roche Austria.All other authors have declared no conflicts of interest."

09-20-2014, 05:46 PM	#20
schoonder Senior Member Join Date: Jul 2008 Posts: 186	Re: Kadcydla versus neurosurgery and paralysis I don't know if Kadcyla crosses the blood-brain barrier, but at ESMO Conference, later this month the following abstract will be discussed. "Abstract Aim Local treatment options such as radiotherapy or neurosurgery are the mainstay of brain metastases (BM) management. Whole brain radiotherapy (WBRT), however, is associated with severe late-toxicity. The LANDSCAPE trial established lapatinib plus capecitabine (LapCap) as primary systemic treatment in oligosymptomatic patients (pts) with multiple Her2-positive BM. Limited evidence exists regarding the activity of antibodies in BM. T-DM1 is an antibody-drug conjugate covalently linking trastuzumab (T) to an anti-microtubule agent (emtansine) with higher activity and lower toxicity as compared to LapCap. Therefore, we evaluated the activity of T-DM1 in newly diagnosed BM or BM progressing after local initial treatment. Methods Nine pts (median age 55 years) with Her2-positive BM treated at two Austrian centres were included. All pts had received prior treatment with T, five pts (55.6%) had already received lapatinib, and two pts (22.2%) pertuzumab as well. In two asymptomatic pts, T-DM1 was administered as primary therapy, while seven pts had documented CNS progression upon prior local treatment. T-DM1 was administered every three weeks at a dose of 3.6 mg/kg. Results Median follow-up was 6 months and median brain metastases-free survival 11 months. Seven pts (two with primary treatment and five receiving T-DM1 upon CNS progression) are currently assessable for CNS response. 3/7 pts (42.9%) had a partial remission, one patient progressing upon prior local therapy had stable disease lasting for fifteen cycles, and one patient had stable disease for 5 month. Two pts with prior WBRT had CNS progression after three treatment cycles. Conclusions This prospective case series again indicates relevant clinical activity of systemic treatment in Her2-positive BM. LapCap remains the standard of care but results of this analysis warrants further investigation of T-DM1 in BM in the context of prospective clinical studies. Disclosure R. Bartsch: has received lecture honoraria, research grants and travel support from Roche Austria. R. Bartsch has received lecture honoraria from GSK Austria; M. Preusser: has received lecture honoraria and research support from Roche Austria.All other authors have declared no conflicts of interest."