Another Reason for a Brain MRI

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.

Thanks Joe, I am giving this to my oncologist because he has not been in favor of doing MRI's unless there are symtoms. He told me and Dana Farber told me that it doesn't matter if mets are found early or late. They are treated the same and all have severe side effects from the radiation. Well, thanks to this board and San Antonio I know differently. I know what they are saying is true but there are those on this board that are doing well such as Christine. I am glad that you are pushing this. It needs to be changed. Blessings, Sandy

I will also show this to may specialist who just told me he doesn't do MRI's until symptoms, but i know better and will do them when i want to. However he has had one brain death in 22 years, which is encouraging, but i'm all for vigilence. Thanks to all of you for watching out for us.
love, joy

[Rozebud]

Joe - How do we fight the "finding mets through scans vs. waiting for symptoms doesn't change prognosis or treatment" mentality so many of us run into? Do you have studies or literature I can quote? Rose

So when saying the recommendation will be that all HER2/NEU positive patients receive MRI's, not just stage IV, do they mean even early stage, such as stage 1 or 2A? The beginning of the article seems to say so, but then later seems to be talking only about patients with metastasis.

When you refer to regular MRIs--how frequently should they be? I now have an annual MRI--Is this considered enough or should it be every 6 months or ?
Kathy

I am an insurance underwriter/agent and have learned to read things through VERY slowly and I'm confused. I read it in relation to women who already HAVE metastatic (minus the CNS) and how many of THEM later developed CNS. I didn't see any mention of NON metastatic women. Joe, could you please clarify? Thank you.

Rhonda

[mamacze]

Joe,
Relevant and timely update, thank you for sharing, I plan to share this with my onc next tuesday and thankyou and Christine both, I am certain if you are not saving lives you are certainly prolonging them and for that our children thank you.
Love, Kim from CT