Research progress in the systemic treatment for breast cancer with brain metastasis

doi:10.3969/j.issn.1674-8115.2021.05.019

Abstract

Abstract:

Breast cancer is one of the most common malignancies in women. Brain metastases occur in approximately 10%–20% of patients with advanced breast cancer. In recent years, with the rapid progress of systemic treatment, extracranial lesions have been effectively controlled and the survival time of patients with breast cancer have been prolonged. Thus the possibility of developing brain metastases has been increased. Moreover, advances in modern diagnostic imaging technology and the routine surveillance of cancer patients have increased the detection rate of brain lesions. Based on the above two aspects, the breast cancer brain metastases (BCBM) have become increasingly common in the clinical settings. Because many chemotherapeutic drugs can not penetrate the blood-brain barrier, the patients with brain metastases have less treatment options, worse survival outcomes and lower quality of life. This article focuses on the recent advances in systemic treatment for BCBM, aiming to provide reference for basic research and clinical practices of this disease.

Key words: breast cancer, brain metastasis, systemic therapy, human epidermal growth factor receptor 2 (HER2), targeted therapy

CLC Number:

R737.9

Jia-ling ZHANG, Feng-chun ZHANG, Ying-chun XU. Research progress in the systemic treatment for breast cancer with brain metastasis[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(5): 671-677.

Figures/Tables 1

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References 60

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Drug	Molecular weight/（g·mol^-1）	Target	Published trail	Outcome	Reference
Lapatinib	581.1	EGFR/HER2	LANDSCAPE	ORR of CNS was 65.9% in BCBM patients treated with lapatinib plus capecitabine	[24]
Neratinib	557.1	EGFR/HER2/HER4	NEfERT-T	Recurrence rate of symptomatic or progressive CNS disease was 8.3% vs 17.3% in neratinib-paclitaxel group and trastuzumab-paclitaxel group, respectively	[25]
			TBCRC022	ORR of CNS was 49% and PFS was 5.5 months in lapatinib-na?ve patients with progressive brain metastases treated with neratinib plus capecitabine	[26]
			NALA	Overall cumulative incidence of intervention for symptomatic CNS disease was 22.8% vs 29.2% for neratinib-capecitabine and lapatinib-capecitabine, respectively	[27]
Tucatinib	480.5	HER2	HER2CLIMB	PFS was 7.6 vs 5.4 months and PFS at 1 year was 24.9% vs 0 in tucatinib-combination group and placebo-combination group, respectively	[28]
Pyrotinib	583.1	EGFR/HER2/HER4	NCT02973737	CNS progression rate was 73.3% vs 87.5%, and time to CNS progression was 168.0 d vs 127.0 d in pyrotinib-capecitabine group and placebo-capecitabine group, respectively	[30]
Abemaciclib	506.6	CDK4/6	NCT02308020	PFS was 4.4 months, and intracranial clinical benefit rate was 25% in BCBM patients treated with abemaciclib	[31]
Talazoparib	380.4	PARP1/2	EMBRACA	PFS was 8.6 vs 5.6 months, and ORR was 62.6% vs 27.2% in patients treated with talazoparib and physician's choice, respectively	[32]

Drug	Molecular weight/（g·mol^-1）	Target	Published trail	Outcome	Reference
Lapatinib	581.1	EGFR/HER2	LANDSCAPE	ORR of CNS was 65.9% in BCBM patients treated with lapatinib plus capecitabine	[24]
Neratinib	557.1	EGFR/HER2/HER4	NEfERT-T	Recurrence rate of symptomatic or progressive CNS disease was 8.3% vs 17.3% in neratinib-paclitaxel group and trastuzumab-paclitaxel group, respectively	[25]
			TBCRC022	ORR of CNS was 49% and PFS was 5.5 months in lapatinib-na?ve patients with progressive brain metastases treated with neratinib plus capecitabine	[26]
			NALA	Overall cumulative incidence of intervention for symptomatic CNS disease was 22.8% vs 29.2% for neratinib-capecitabine and lapatinib-capecitabine, respectively	[27]
Tucatinib	480.5	HER2	HER2CLIMB	PFS was 7.6 vs 5.4 months and PFS at 1 year was 24.9% vs 0 in tucatinib-combination group and placebo-combination group, respectively	[28]
Pyrotinib	583.1	EGFR/HER2/HER4	NCT02973737	CNS progression rate was 73.3% vs 87.5%, and time to CNS progression was 168.0 d vs 127.0 d in pyrotinib-capecitabine group and placebo-capecitabine group, respectively	[30]
Abemaciclib	506.6	CDK4/6	NCT02308020	PFS was 4.4 months, and intracranial clinical benefit rate was 25% in BCBM patients treated with abemaciclib	[31]
Talazoparib	380.4	PARP1/2	EMBRACA	PFS was 8.6 vs 5.6 months, and ORR was 62.6% vs 27.2% in patients treated with talazoparib and physician's choice, respectively	[32]

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