Chemoradiotherapy feasible in breast cancer with brain metastases

NEW YORK (Reuters Health) - Breast cancer patients with brain metastases benefit from treatment with IV chemotherapy in combination with radiotherapy, according to a report in the November 1st issue of Cancer.

Whole brain radiotherapy (WBRT) is a cornerstone of treatment for patients with brain metastases, the authors explain, but the role of systemic chemotherapy for these patients remains unclear.

In a phase 2 trial, Dr. Philippe A. Cassier from Edouard Herriot Hospital in Lyon, France, and colleagues assessed the safety, tolerability and efficacy of concurrent therapy with cisplatin, vinorelbine and WBRT in 25 women with previously untreated brain metastases from breast cancer.

Three patients (12%) had complete disappearance of brain metastases, 16 (64%) had partial responses, and 2 had stable disease for several months, the authors report.

Median time to progression of brain disease was 5.2 months from study entry, with a median duration of response of 8.5 months.

Systemic responses (cerebral and extracerebral disease) were complete in 1 patient and partial in 10, for an overall response rate of 44%, the authors said. Five patients had stable disease for a median 4.2 months.

Median systemic progression-free survival was 3.7 months from study entry, the researchers note, with 4 patients remaining progression-free at 12 months.

The median overall survival was 6.5 months, the investigators say, with 7 patients (28%) alive at 12 months after study entry.

Side effects from WBRT were generally mild, the report indicates, but most patients experienced grade 3-4 hematologic toxicities likely related to the chemotherapy. Eleven women (44%) discontinued treatment because of disease progression or toxicity.

The authors conclude that "chemotherapy with cisplatin and vinorelbine combined with concurrent WBRT is feasible and induces a high response rate in brain metastases from breast cancer while providing an interesting response rate of systemic disease, and has an acceptable toxicity profile."

"However," they add, "despite this high rate of cerebral control, benefit in overall survival appears to be marginal compared with radiotherapy alone. This combination could therefore have interest for patients with both cerebral and extracerebral progression."

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