Central nervous system progression among patients with metastatic breast cancer responding to trastuzumab treatment
Central nervous system progression among patients with metastatic breast cancer responding to trastuzumab treatment
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DOI：
10.1016/j.ejca.2003.09.018
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发表时间：
2004-02-01
影响因子：
8.4
通讯作者：
Inbar, M
中科院分区：
文献类型：
--
作者：
Shmueli, E;Wigler, N;Inbar, M
乳腺癌的中枢神经系统（CNS）转移很常见，可作为疾病进展的第一个或孤立部位。据报道，中枢神经系统作为一个避难所网站，拒绝进入许多化疗药物。我们在这里介绍了一系列的10例转移性乳腺癌患者，他们在曲妥珠单抗治疗后出现CNS转移。在曲妥珠单抗治疗期间，对41例转移性HER2过表达乳腺癌患者进行了随访，这些患者在开始曲妥珠单抗治疗前没有CNS受累的证据。在治疗过程中出现神经系统体征或症状的患者中进行神经系统评价。在这些患者的CNS参与的临床过程和模式进行了讨论。32例患者（78%）显示对曲妥珠单抗治疗的初始应答。10例（31%）缓解患者在曲妥珠单抗治疗开始后中位43周发生孤立CNS复发或并发CNS和全身性进展。在3例患者的脑部症状得到控制后，继续使用曲妥珠单抗单药治疗，2例患者分别在诊断为CNS转移后11周和15周出现全身性疾病进展体征。在另外两名患者中，曲妥珠单抗联合每周化疗在CNS复发后持续20周以上，无疾病进展证据。我们组患者中CNS受累的发生率高于预期。随着新型药物组合实现更成功和更持久的全身抗肿瘤作用，发生CNS转移的风险可能更大。预防性颅照射策略的评价可能是研究高风险患者。(C)2003爱思唯尔有限公司。保留所有权利。
Central nervous system (CNS) metastases from breast cancer are common and can present as the first or solitary site of disease progression. The CNS has been reported to act as a sanctuary site that denies access to many chemotherapeutic agents. We present here, a series of 10 metastatic breast cancer patients who developed CNS metastases after an initial response to trastuzumab treatment. Forty one patients with metastatic HER2-overexpressing breast cancer, without evidence of CNS involvement prior to the initiation of trastuzumab treatment, were followed during trastuzumab treatment. A neurological evaluation was performed in those patients who developed neurological signs or symptoms during the course of treatment. The clinical course and pattern of CNS involvement in these patients are discussed. Thirty two patients (78%) showed an initial response to trastuzumab treatment. Ten (31%) of the responding patients developed either isolated CNS relapse or concurrent CNS and systemic progression at a median of 43 weeks after the initiation of trastuzumab treatment. Trastuzumab as a single agent was continued following control of brain symptoms in three patients, two showed signs of systemic disease progression at 11 and 15 weeks following the diagnosis of CNS metastases, respectively. In two other patients, trastuzumab in combination with weekly chemotherapy was continued for more than 20 weeks after CNS relapse without evidence of disease progression. The incidence of CNS involvement in our group of patients was higher than expected. With more successful and prolonged systemic anti-tumour effects achieved by novel drug combinations, the risk of developing CNS metastases might be even greater. Evaluation of prophylactic cranial irradiation strategies might be studied for high-risk patients. (C) 2003 Elsevier Ltd. All rights reserved.