Drug Combo Tackles Brain Mets in Breast Cancer

Brain MetsBy Crystal Phend, Senior Staff Writer, MedPage Today
Published: November 01, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, BSN, RN, Nurse Planner

The combination of the biologic lapatinib (Tykerb) and capecitabine (Xeloda) chemotherapy appears to shrink brain metastases from HER2-positive breast cancer without need for radiation, a phase II trial showed.

Two-thirds of patients saw their previously-untreated brain lesions shrink by at least half with the treatment regimen, Thomas Bachelot, MD, of the Centre Léon Bérard in Lyon, France, and colleagues found in the LANDSCAPE trial. [Read more…]

The Role of Radiosurgery in the Management of Brain Metastases

a report by David Roberge, MD

Assistant Professor, Radiation Oncology, McGill University

It was decades after the introduction of the first concept of stereotactic radiosurgery (SRS) at the Karolinska Institute1 that stereotactic irradiation began to see widespread use in the treatment of brain tumors. Despite many technical changes since the 1950s, radiosurgery remains a radiotherapy technique characterized by accurate delivery of high doses of radiation in a single session to small, stereotactically defined targets with sharp dose fall-off outside the targeted volume. Such a treatment appears ideally suited to parenchymal brain metastases—tumors geographically well delimited with minimal infiltration into the adjacent brain.2 Unfortunately, such metastases are a common occurrence, representing approximately 250,000 cases per year in the US alone.3 Thus, even if only a fraction of these patients are referred for SRS, the management of brain metastases invariably represents a significant fraction of the workload of a radiosurgery practice. Until recently most reports supporting the use of SRS were retrospective case series. This has changed with the publication of randomized trials characterizing the benefits of SRS in the management of newly diagnosed brain oligometastases. [Read more…]

Current Trends in the Treatment for Brain Metastasis

Antonio Marcilio Padula Omuro is an Attending Physician at the Hôpital Pitié-Salpétrière in Paris. He has published several papers on brain tumours and is a member of the European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumor Group. Dr Omuro trained in neurology at the University of São Paulo, Brazil, and in clinical neuro-oncology at the Memorial Sloan-Kettering Cancer Center, New York.

Brain metastasis is a feared complication of cancer that is associated with a significant decrease in quality of life and a dismal prognosis. The risk of developing brain metastasis has been estimated at around 25% in all cancer patients; however, this incidence has been increasing in many common cancer types, particularly breast and NSCLC. This can be explained by several factors including the inability of certain chemotherapy agents to cross an intact blood–brain barrier (BBB), as well as an inherent propensity for the development of brain metastasis observed in long-term cancer survivors. [Read more…]