Compiling Data on HER2 Brain Mets

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This article is very much about the central nervous system as the first site of mets for HER2.


Incidence of central nervous system metastases in patients with HER2-positive metastatic breast cancer treated with pertuzumab, trastuzumab, and docetaxel: results from the randomized phase III study CLEOPATRA (2014)

http://m.annonc.oxfordjournals.org/c...25/6/1116.full

"Results from CLEOPATRA have demonstrated that the combination of pertuzumab with trastuzumab and docetaxel further improves systemic disease control by trastuzumab plus docetaxel, resulting in a significant and clinically meaningful prolongation of median progression-free [median time 15 months vs 11.9 months placebo group] and overall survival [median time34.4 months vs 26.3 months with placebo]. Our results presented here suggest that this improvement in systemic disease control with pertuzumab-based treatment delays the onset of CNS disease. Advances in systemic disease control and overall survival may result in an increase in the number of patients who will eventually develop CNS metastases; therefore, better treatment options for CNS disease are needed to increase quality of life and prolong survival of these patients. Based on results from CLEOPATRA, further investigation into the activity of HER2-targeted antibodies in patients with CNS disease from HER2-positive breast cancer is warranted"

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"It is estimated that 10-35% of patients diagnosed with breast cancer will develop metastasis to the brain. Although patients with localized disease have a low probability of initial brain metastasis (BM), those with regional and metastatic disease have a 7.6% and 13.5% risk of BM at diagnosis, respectively, while those with HER-2 positive disease or ER-negative disease may be at an even higher risk, especially in the context of other visceral metastases, such as the liver. Current international guidelines for the evaluation of a new patient with breast cancer recommend screening for BM only if there are suspicious clinical symptoms, and not as a routine test. For patients with neurological symptoms, such as progressive headache, motor dysfunction, or sensation changes, there should be a low threshold for ordering an MRI of the brain. Treatment options for breast cancer brain metastases (BCBM) include surgery with/without adjuvant radiotherapy (whole brain or tumor-bed alone), whole-brain radiotherapy (with or without a focal boost, such as radiosurgery), radiosurgery alone, and potentially, systemic or targeted therapy, either used singly or in conjunction with other localized therapeutic approaches."

Management of solitary and multiple brain metastases from breast cancer (2015)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477383/

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Long-term Survival after Cerebellar Metastasis Resection from Her2 3+ Locally Advanced Breast Cancer (2015)
http://www.touchoncology.com/article...dvanced-breast

We present a patient who first developed a distant metastatic site in the cerebellum during treatment for Her2 3+ locally advanced breast cancer (LABC). LABC was in complete remission at that time and isolated cerebellar metastasis was resected. The patient is still alive more than 135 months after LABC diagnosis, and more than 99 months after neurosurgery, and is still receiving trastuzumab without further progression or any toxicity. To the best of our knowledge, this is first report of such exceptional disease course for a patient with a predicted grave prognosis according to all prognostic parameters.