Trastuzumab for Breast Cancer Linked to CNS Metastases

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woman checking breastWOMEN with HER2-positive breast cancer who receive adjuvant trastuzumab (Herceptin, Genentech/Roche) have a significant risk for metastases in the central nervous system (CNS) as the site of first recurrence, according to a report published online March 4 in the Annals of Oncology.

“While adjuvant trastuzumab has dramatically lowered the risk of recurrence in HER2-positive breast cancer patients, clinicians should be cognizant of CNS disease as the first site of relapse and monitor survivors closely for worrisome neurologic symptoms,” lead author Erin M. Olson, MD, from The Ohio State University in Columbus, told Medscape Medical News.

It has been suggested that the CNS is a sanctuary site for micrometastatic disease, either because trastuzumab does not penetrate the blood–brain barrier or because of the loss ofHER2 overexpression in breast cancer cells migrating to the brain, Dr. Olson said.

In previous work, she and her colleagues found an increasing incidence of brain metastases in patients with prolonged exposure to HER2-targeted therapies. This discovery prompted her team to explore the incidence of the CNS as the first site of relapse after exposure to adjuvant trastuzumab.

They analyzed 4 phase 3 randomized controlled trials (NSABP B31, NCCTG N9831, HERA, and PACS), which involved 9020 patients in total…Read more.



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