Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02)
Introduction, A decade ago, stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) was emerging as preferred treatment for oligometastatic brain metastases. Studies of cavity SRS after neurosurgery were underway. Data specific to metastatic HER2 breast cancer (MHBC), describing intr...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977624000067 |
| _version_ | 1797247939258613760 |
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| author | Claire Phillips Mark B. Pinkham Alisha Moore Joseph Sia Rosalind L. Jeffree Mustafa Khasraw Anthony Kam Mathias Bressel Annette Haworth |
| author_facet | Claire Phillips Mark B. Pinkham Alisha Moore Joseph Sia Rosalind L. Jeffree Mustafa Khasraw Anthony Kam Mathias Bressel Annette Haworth |
| author_sort | Claire Phillips |
| collection | DOAJ |
| description | Introduction, A decade ago, stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) was emerging as preferred treatment for oligometastatic brain metastases. Studies of cavity SRS after neurosurgery were underway. Data specific to metastatic HER2 breast cancer (MHBC), describing intracranial, systemic and survival outcomes without WBRT, were lacking. A Phase II study was designed to address this gap.Method, Adults with MHBC, performance status 0–2, ≤ five BrM, receiving/planned to receive HER2-targeted therapy were eligible. Exclusions included leptomeningeal disease and prior WBRT. Neurosurgery allowed ≤6 weeks before registration and required for BrM >4 cm. Primary endpoint was 12-month requirement for WBRT. Secondary endpoints; freedom from (FF-) local failure (LF), distant brain failure (DBF), extracranial disease failure (ECDF), overall survival (OS), cause of death, mini-mental state examination (MMSE), adverse events (AE).Results, Twenty-five patients accrued Decembers 2016–2020. The study closed early after slow accrual. Thirty-seven BrM and four cavities received SRS. Four cavities and five BrM were observed. At 12 months: one patient required WBRT (FF-WBRT 95 %, 95 % CI 72–99), FFLF 91 % (95 % CI 69–98), FFDBF 57 % (95 % CI 34–74), FFECDF 64 % (95 % CI 45–84), OS 96 % (95 % CI 74–99). Two grade 3 AE occurred. MMSE was abnormal for 3/24 patients at baseline and 1/17 at 12 months.Conclusion, At 12 months, SRS and/or neurosurgery provided good control with low toxicity. WBRT was not required in 95 % of cases. This small study supports the practice change from WBRT to local therapies for MHBC BrM. |
| first_indexed | 2024-03-08T03:31:15Z |
| format | Article |
| id | doaj.art-5bbf88fff8074d858a7f8e564ecedb00 |
| institution | Directory Open Access Journal |
| issn | 1532-3080 |
| language | English |
| last_indexed | 2024-04-24T20:06:39Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj.art-5bbf88fff8074d858a7f8e564ecedb002024-03-24T06:56:30ZengElsevierBreast1532-30802024-04-0174103675Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02)Claire Phillips0Mark B. Pinkham1Alisha Moore2Joseph Sia3Rosalind L. Jeffree4Mustafa Khasraw5Anthony Kam6Mathias Bressel7Annette Haworth8Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, Australia; Corresponding author. Peter MacCallum Cancer Centre 305 Grattan Street, Melbourne, 3000, Australia.Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, AustraliaTrans-Tasman Radiation Oncology Group, Newcastle, AustraliaPeter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, AustraliaFaculty of Medicine, University of Queensland, Brisbane, Australia; Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, AustraliaRoyal Melbourne Hospital, Parkville, AustraliaThe Alfred, Prahran, Australia; Monash University, Clayton, AustraliaPeter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology University of Melbourne, Parkville, AustraliaDepartment of Physics, University of Sydney, Sydney, AustraliaIntroduction, A decade ago, stereotactic radiosurgery (SRS) without whole brain radiotherapy (WBRT) was emerging as preferred treatment for oligometastatic brain metastases. Studies of cavity SRS after neurosurgery were underway. Data specific to metastatic HER2 breast cancer (MHBC), describing intracranial, systemic and survival outcomes without WBRT, were lacking. A Phase II study was designed to address this gap.Method, Adults with MHBC, performance status 0–2, ≤ five BrM, receiving/planned to receive HER2-targeted therapy were eligible. Exclusions included leptomeningeal disease and prior WBRT. Neurosurgery allowed ≤6 weeks before registration and required for BrM >4 cm. Primary endpoint was 12-month requirement for WBRT. Secondary endpoints; freedom from (FF-) local failure (LF), distant brain failure (DBF), extracranial disease failure (ECDF), overall survival (OS), cause of death, mini-mental state examination (MMSE), adverse events (AE).Results, Twenty-five patients accrued Decembers 2016–2020. The study closed early after slow accrual. Thirty-seven BrM and four cavities received SRS. Four cavities and five BrM were observed. At 12 months: one patient required WBRT (FF-WBRT 95 %, 95 % CI 72–99), FFLF 91 % (95 % CI 69–98), FFDBF 57 % (95 % CI 34–74), FFECDF 64 % (95 % CI 45–84), OS 96 % (95 % CI 74–99). Two grade 3 AE occurred. MMSE was abnormal for 3/24 patients at baseline and 1/17 at 12 months.Conclusion, At 12 months, SRS and/or neurosurgery provided good control with low toxicity. WBRT was not required in 95 % of cases. This small study supports the practice change from WBRT to local therapies for MHBC BrM.http://www.sciencedirect.com/science/article/pii/S0960977624000067HER2+ breast cancerBrain metastasesRadiosurgeryWhole brain radiotherapyHER2-Targeted therapy |
| spellingShingle | Claire Phillips Mark B. Pinkham Alisha Moore Joseph Sia Rosalind L. Jeffree Mustafa Khasraw Anthony Kam Mathias Bressel Annette Haworth Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) Breast HER2+ breast cancer Brain metastases Radiosurgery Whole brain radiotherapy HER2-Targeted therapy |
| title | Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) |
| title_full | Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) |
| title_fullStr | Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) |
| title_full_unstemmed | Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) |
| title_short | Local hero: A phase II study of local therapy only (stereotactic radiosurgery and / or surgery) for treatment of up to five brain metastases from HER2+ breast cancer. (TROG study 16.02) |
| title_sort | local hero a phase ii study of local therapy only stereotactic radiosurgery and or surgery for treatment of up to five brain metastases from her2 breast cancer trog study 16 02 |
| topic | HER2+ breast cancer Brain metastases Radiosurgery Whole brain radiotherapy HER2-Targeted therapy |
| url | http://www.sciencedirect.com/science/article/pii/S0960977624000067 |
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