Surgery has always to be considered when feasible. It is now well established that stereotaxic radiosurgery allows for equivalent control and less-cognitive toxicities than whole-brain radiation therapy, which should be delayed as much as possible. Medical treatment for BCBM is currently a rapidly evolving field. It has been shown that the blood-brain barrier (BBB) is often impaired in macroscopic BM, and several chemotherapy regimens, antibody-drug conjugates and tyrosine-kinase inhibitors have been shown to be active on BCBM and can be part of the global treatment strategy.
Treatment strategies for breast cancer brain metastases
Review Br J Cancer
Caroline Bailleux 1, Lauriane Eberst 2, Thomas Bachelot 3Affiliations expand
- PMID: 33250512
- PMCID: PMC7782834 (available on 2021-11-30)
- DOI: 10.1038/s41416-020-01175-y
Abstract
Brain metastases from breast cancer (BCBM) constitute the second most common cause of brain metastasis (BM), and the incidence of these frequently lethal lesions is currently increasing, following better systemic treatment. Patients with ER-negative and HER2-positive metastatic breast cancer (BC) are the most likely to develop BM, but if this diagnosis remains associated with a worse prognosis, long survival is now common for patients with HER2-positive BC. BCBM represents a therapeutic challenge that needs a coordinated treatment strategy along international guidelines. Surgery has always to be considered when feasible. It is now well established that stereotaxic radiosurgery allows for equivalent control and less-cognitive toxicities than whole-brain radiation therapy, which should be delayed as much as possible. Medical treatment for BCBM is currently a rapidly evolving field. It has been shown that the blood-brain barrier (BBB) is often impaired in macroscopic BM, and several chemotherapy regimens, antibody-drug conjugates and tyrosine-kinase inhibitors have been shown to be active on BCBM and can be part of the global treatment strategy. This paper provides an overview of the therapeutic option for BCBM that is currently available and outlines potential new approaches for tackling these deadly secondary tumours.
Conflict of interest statement
C.B. and L.E. declare no conflict of interest. T.B. reports personal fees and non-financial support from Roche, grants, personal fees and non-financial support from Novartis, grants, personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Pfizer, personal fees from SeattleGenetics, outside the submitted work.
Similar articles
- Investigational chemotherapy and novel pharmacokinetic mechanisms for the treatment of breast cancer brain metastases.Shah N, Mohammad AS, Saralkar P, Sprowls SA, Vickers SD, John D, Tallman RM, Lucke-Wold BP, Jarrell KE, Pinti M, Nolan RL, Lockman PR.Pharmacol Res. 2018 Jun;132:47-68. doi: 10.1016/j.phrs.2018.03.021. Epub 2018 Mar 28.PMID: 29604436 Free PMC article. Review.
- New insights and emerging therapies for breast cancer brain metastases.Lim E, Lin NU.Oncology (Williston Park). 2012 Jul;26(7):652-9, 663.PMID: 22888567 Review.
- Stereotactic radiosurgery with concurrent lapatinib is associated with improved local control for HER2-positive breast cancer brain metastases.Parsai S, Miller JA, Juloori A, Chao ST, Kotecha R, Mohammadi AM, Ahluwalia MS, Murphy ES, Barnett GH, Vogelbaum MA, Angelov L, Peereboom DM, Suh JH.J Neurosurg. 2019 Feb 8;132(2):503-511. doi: 10.3171/2018.10.JNS182340.PMID: 30738402
- Changing Natural History of HER2-Positive Breast Cancer Metastatic to the Brain in the Era of New Targeted Therapies.Mounsey LA, Deal AM, Keith KC, Benbow JM, Shachar SS, Zagar T, Dees EC, Carey LA, Ewend MG, Anders CK.Clin Breast Cancer. 2018 Feb;18(1):29-37. doi: 10.1016/j.clbc.2017.07.017. Epub 2017 Aug 9.PMID: 28867445
- A Multidisciplinary Breast Cancer Brain Metastases Clinic: The University of North Carolina Experience.McKee MJ, Keith K, Deal AM, Garrett AL, Wheless AA, Green RL, Benbow JM, Dees EC, Carey LA, Ewend MG, Anders CK, Zagar TM.Oncologist. 2016 Jan;21(1):16-20. doi: 10.1634/theoncologist.2015-0328. Epub 2015 Dec 9.PMID: 26659221 Free PMC article.
Cited by 2 articles
- Is Molecular Tailored-Therapy Changing the Paradigm for CNS Metastases in Breast Cancer?Di Nunno V, Franceschi E, Tosoni A, Mura A, Minichillo S, Di Battista M, Gatto L, Maggio I, Lodi R, Bartolini S, Brandes AA.Clin Drug Investig. 2021 Sep;41(9):757-773. doi: 10.1007/s40261-021-01070-1. Epub 2021 Aug 17.PMID: 34403132 Review.
- Breast Cancer Brain Metastasis-Overview of Disease State, Treatment Options and Future Perspectives.Watase C, Shiino S, Shimoi T, Noguchi E, Kaneda T, Yamamoto Y, Yonemori K, Takayama S, Suto A.Cancers (Basel). 2021 Mar 3;13(5):1078. doi: 10.3390/cancers13051078.PMID: 33802424 Free PMC article. Review.
References
- Weil RJ, Palmieri DC, Bronder JL, Stark AM, Steeg PS. Breast cancer metastasis to the central nervous system. Am. J. Pathol. 2005;167:913–920. – PMC – PubMed
SAIBA MAIS SOBRE O BLOG
Editor do blog: Julio Pereira – Neurocirugião – São Paulo CRM/SP 163.113 Site para Consulta: https://www.julio-pereira.com/ Consultório: (11)99503-8838 (WhatsApp) / (11)4200-2300 Atuando no Hospital Sírio-Libanês e na BP – A Beneficência Portuguesa de São Paulo.
