Abstract
Abstract Background: Breast cancer remains the second leading cause of CNS metastases. HER2 positive and triple negative subtypes are especially and independently at higher risk of developing brain metastases. Although surgical resection and radiosurgery may play a role in the management of selected cases, whole brain radiation therapy remains the standard treatment but with limited efficacy. Temozolomide (TMZ); an oral alkylating agent that cross the blood brain barrier has shown radiosensitizing characteristics as well as synergistic effects of radiation therapy (RT). The aim of the study was to assess the efficacy and safety of WBRT with concomitant TMZ in treatment of brain metastases in breast cancer patients. Patients and methods: A prospective randomized study included 60 patients with newly diagnosed brain metastases (BMs) from breast cancer not candidate for surgical resection or radiosurgery. All patients received WBRT 30 Gy/10 fractions with or without TMZ, administered at a dosage of 75 mg/m2/day during the irradiation period. The primary end point was objective response rate (ORR) 6 weeks after the end of treatment defined as partial response (PR) or complete response (CR) on brain MRI (WHO criteria). Secondary end points were progression-free survival (PFS) and overall survival (OS), neurological symptoms and tolerability. Results: Between October 2011 and October 2013, 60 patients were enrolled in the study, 30 patients received WBRT+TMZ (group A) and 30 patients received WBRT (group B). Median age was 54 years (30-65), median follow up was 10.4 months (3-36). ORR was 80% in the WBRT+TMZ arm versus 50% in the WBRT (p = 0.017). The median PFS were 11.8 versus 5.8 respectively (p = 0.005). The median OS was 13.8 for group A and 10.8 for group B (p = 0.59). WBRT+TMZ was well tolerated with mostly grade 2 non-hematologic toxicity; headache, nausea & vomiting were 6%, 15% & 12% in group A versus 12%, 9% & 6% in group B, respectively. While the most evident hematologic toxicity recorded was lymphopenia grade 2 & 3 (15% & 12% in group A) and (12% & 9% in group B). No grade 4 toxicities were noted. Conclusion: WBRT plus TMZ improve local control and response rate of BMs from breast cancer, which was reflected by improved PFS. Citation Format: El-Sadda WM, Abdel-Halim II, El-Ibrashi MM, Magdi MM. Whole brain radiation therapy (WBRT) with or without concurrent temozolomide for brain metastases in breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-17-09.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call