Abstract
BackgroundLittle is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM).MethodsTwenty-three patients with BCBM underwent 31 stereotactic sessions to 90 lesions from 2005 to 2019 with receipt of capecitabine. The Kaplan-Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of stereotactic radiation. Imaging was independently reviewed by a neuro-radiologist.ResultsMedian follow-up from stereotactic radiation was 9.2 months. Receptor types of patients treated included triple negative (n = 7), hormone receptor (HR)+/HER2- (n = 7), HR+/HER2+ (n = 6), and HR−/HER2+ (n = 3). Fourteen patients had stage IV disease prior to BCBM diagnosis. The median number of brain metastases treated per patient was 3 (1 to 12). The median dose of stereotactic radiosurgery (SRS) was 21 Gy (range: 15–24 Gy) treated in a single fraction and for lesions treated with fractionated stereotactic radiation therapy (FSRT) 25 Gy (24–30 Gy) in a median of 5 fractions (range: 3–5). Of the 31 stereotactic sessions, 71% occurred within 1 month of capecitabine. No increased toxicity was noted in our series with no cases of radionecrosis. The 1-year OS, LC, and DIC were 46, 88, and 30%, respectively.ConclusionsIn our single institution experience, we demonstrate stereotactic radiation and capecitabine to be a safe treatment for patients with BCBM with adequate LC. Further study is needed to determine the potential synergy between stereotactic radiation and capecitabine in the management of BCBM.
Highlights
Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM)
In the management of HER2+ BCBM, capecitabine has been combined with the HER tyrosine kinase inhibitor (TKI) lapatinib demonstrating a central nervous system (CNS) response rate of 66% [6]
Capecitabine alone is commonly prescribed in the adjuvant setting in triple negative tumors following results of the CREATE-X trial which demonstrated the rate of disease-free survival as 69.8% in the capecitabine group versus 56.1% in the control group and improved overall survival (OS) [8]
Summary
Little is known about the safety and efficacy of concurrent capecitabine and stereotactic radiotherapy in the setting of breast cancer brain metastases (BCBM). In the management of HER2+ BCBM, capecitabine has been combined with the HER tyrosine kinase inhibitor (TKI) lapatinib demonstrating a central nervous system (CNS) response rate of 66% [6]. The HER TKI neratinib demonstrated activity against HER2-positive BCBM with an objective response rate of 49% in lapatinib naive patients [7]. Capecitabine alone is commonly prescribed in the adjuvant setting in triple negative tumors following results of the CREATE-X trial which demonstrated the rate of disease-free survival as 69.8% in the capecitabine group versus 56.1% in the control group and improved overall survival (OS) [8]
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