Vaseem M Khatri, Mariella A Mestres-Villanueva, Sierra Daniel, Sreenija Yarlagadda, Ajay Doniparthi, Rituraj Upadhyay, Matthew N Mills, Daniel E Oliver, Hsiang-Hsuan Michael Yu, Joshua D Palmer, Daniel G Stover, Nicole O Williams, Reshma L Mahtani, Manmeet S Ahluwalia, Aixa E Soyano, Hatem H Soliman, Hyo S Han, Rupesh Kotecha, Sasha J Beyer, Kamran A Ahmed
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引用次数: 0
Abstract
Purpose: Improved treatment strategies are needed for HER2 negative breast cancer brain metastases (BCBM). Stereotactic radiosurgery (SRS) is the standard of care for limited brain metastases. Sacituzumab govitecan (SG) may have intracranial efficacy for BCBM; however, safety and efficacy data remain limited when combined with SRS.
Methods: A multi-institutional retrospective review was performed of patients with HR+/HER2- and triple negative (TNBC) BCBM treated with SG and SRS for active BMs at three institutions. Concurrent SG and SRS was defined as SRS after the date of first SG infusion and before or on the date of last SG infusion. Safety was assessed as well as distant intracranial control (DIC), systemic and central nervous systemic (CNS) progression-free survival (PFS), local control (LC), and overall survival (OS).
Results: A total of 277 lesions were treated over 36 SRS courses in 26 patients. Median follow up from SG initiation was 23.3 months. One hundred sixty-eight (61%) lesions were treated with single fraction SRS and 109 (39%) lesions were treated with fractionated SRS (fSRS). One hundred thirty-five (47%) lesions received concurrent SRS and SG. No cases of symptomatic radiation necrosis (SRN) were noted. LC rates at 12- and 24-months were 94% and 84%, respectively. Median CNS-PFS was 5.4 months (95% CI 2.8-7.3). Median systemic PFS was 4.4 months (95% CI 2.2-7.3 months). Median overall survival was 8.4 months with a 24-month rate of 16%.
Conclusion: In our series, concurrent SRS and SG was associated with excellent local control, without an increased risk of SRN. Prospective investigation into potential synergy is warranted.
目的：改进HER2阴性乳腺癌脑转移（BCBM）的治疗策略。立体定向放射外科（SRS）是有限脑转移的标准治疗方法。Sacituzumab govitecan （SG）可能对BCBM有颅内疗效；然而，当与SRS联合使用时，安全性和有效性数据仍然有限。方法：对三家医院接受SG和SRS治疗活动性脑转移的HR+/HER2-和三阴性（TNBC） BCBM患者进行多机构回顾性研究。同时SG和SRS被定义为在第一次SG输注日期之后和最后一次SG输注日期之前或之后的SRS。评估安全性以及远端颅内控制（DIC）、全身和中枢神经系统（CNS）无进展生存（PFS）、局部控制（LC）和总生存（OS）。结果：26例患者共治疗了277个病灶，共36个SRS疗程。SG开始后的中位随访时间为23.3个月。168例（61%）病灶采用单段SRS治疗，109例（39%）病灶采用分段SRS （fSRS）治疗。135例（47%）病变同时接受SRS和SG治疗。无症状性放射性坏死（SRN）病例。12个月和24个月的LC率分别为94%和84%。中位CNS-PFS为5.4个月（95% CI 2.8-7.3）。中位系统PFS为4.4个月（95% CI 2.2-7.3个月）。中位总生存期为8.4个月，24个月生存率为16%。结论：在我们的研究中，并发SRS和SG与良好的局部控制相关，没有增加SRN的风险。对潜在协同作用的前瞻性调查是必要的。
期刊介绍：
The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.
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