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Ms. Musa Myer a long time survivor and author of several books on metastatic breast cancer sent me this abstract of a paper authored by Dr. Eric Winer and Dr. Dennis Slamon among others.
The important thing to note is that: "Nearly 10% of patients receiving trastuzumab in combination with chemotherapy developed isolated CNS metastases as first site of tumor progression."
Our group has changed our thinking and will be pushing for regular brain MRI's for all HER2 patients, not only stage IV at SABCS this year.
Warmest Regards
Joe
Department of Medical Oncology, Dana-Farber Cancer Institute,
Department of Medicine, Brigham & Women's Hospital, Harvard Medical
School, Boston, MA.
Purpose: The aim of this study was to characterize the prevalence and
predictors of central nervous system (CNS) metastasis among women
with HER2-overexpressing metastatic breast cancer receiving
trastuzumab-based therapy.
METHODS: The frequency and time course of isolated CNS progression
were characterized among women with HER2-positive metastatic breast
cancer, receiving chemotherapy with or without trastuzumab as
first-line treatment for metastatic disease in two clinical trials.
The first trial was a multicenter randomized phase III study of
chemotherapy (doxorubicin/cyclophosphamide or paclitaxel) +/-
trastuzumab, and the second was a multicenter phase II trial of
vinorelbine + trastuzumab. All patients had measurable disease and
were free of symptomatic CNS disease at initiation of study treatment.
RESULTS: Nearly 10% of patients receiving trastuzumab in combination
with chemotherapy developed isolated CNS metastases as first site of
tumor progression. Progression in the CNS tended to be a later event
than progression at other sites among women receiving
trastuzumab-based therapy. Trastuzumab-based treatment did not
substantially delay onset of CNS metastases as initial site of
progression. Following diagnosis with primary breast cancer, tumors
with HER2 gene amplification tend to be associated with greater risk
of isolated CNS progression compared with those lacking gene amplification.
CONCLUSIONS: Patients with HER2-overexpressing metastatic breast
cancer are at risk for isolated CNS progression, reflecting improved
peripheral tumor control and patient survival through use of
trastuzumab-based therapy, and a relative lack of CNS activity with
trastuzumab. Clinicians should be aware of this association. Better
treatments for CNS recurrences are needed.
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