Cisplatin Plus Gemcitabine for Treatment of Breast Cancer Patients with Brain Metastases: a Preferential Option for Triple Negative Patients?

Cigdem Erten,Ahmet Alacacioglu,Yuksel Kucukzeybek,Isil Somali,Vedat Bayoglu,Alper Can,Lutfiye Demir,Mustafa Oktay Tarhan,Ahmet Dirican,Murat Akyol

doi:10.7314/apjcp.2013.14.6.3711

Abstract

To assess the efficacy and tolerability of Cisplatin plus Gemcitabine combination in patients with brain metastases (BM) from breast cancer (BC). Eighteen BC patients with BM who were treated with Cisplatin plus Gemcitabine regimen between 2003-2011 were evaluated. A median of 6 cycles of this regimen were received, in fifteen patients (83.3%) as first-line chemotherapy, in 2 as second- line and in 1 as third-line after diagnosis of BM. Dose reduction was performed in 11 (61.1%) patients; major reasons were neutropenia and leukopenia. Grade III neutropenia and Grade II trombocytopenia rates were 33.3% and 16.7% respectively. Overall response rate (ORR; complete+partial response rate) was 33.4% (n=6) for the entire study population; triple negative patients achieved an 66.6% ORR while hormone receptor (HR) positive patients had 25% and HER2 positive patients 12.5%. Median progression-free survival was 5.6 months (2.4-8.8 months, 95%CI) and longer in patients with triple negative breast cancer (TNBC) (median 7.4 months, 95%CI, 2.4-12.3 months) than the patients with other subtypes (median 5 months for HER2 positive and 3.6 months for HR positive patients). Median PFS of the patients with TNBC who received this regimen as first-line was 9.2 months (5.2-13.2 months, 95%CI). Cisplatin plus Gemcitabine may be a treatment option for patients with BM from breast cancer. Longer PFS and higher response rates are results that support the usage of this regimen especially for the triple negative subtype. However, further prospective and randomized trials are clearly required to provide more exact information.

Highlights

Breast cancer is the second most common cause of brain metastases, approximately, 10-16% of the metastatic breast cancer patients develop BM
Patients We retrospectively evaluated 18 patients who were diagnosed with BM due to breast cancer between 20032011 at a single center (Izmir Katip Celebi University, Ataturk Training and Research Hospital, Department of Medical Oncology) and were treated with Cisplatin plus Gemcitabine regimen at any line after BM
Cisplatin Plus Gemcitabine for Breast Cancer Patients with Brain Metastases following tumor subtypes were defined according to hormone receptor (HR) therapy for these cases due to the triple negative nature of and human epidermal growth receptor-2 (HER2) status: i) HR positive, HER2 negative

Summary

Introduction

Breast cancer is the second most common cause of brain metastases, approximately, 10-16% of the metastatic breast cancer patients develop BM. Several retrospective studies demonstrated that systemic therapy after BM prolongs survival compared with only radiation therapy or best supportive care (Park et al, 2009; Niwinska et al, 2010; Kim et al, 2012). It is still not clear which therapy option is most effective. The combination of Cisplatin and Gemcitabine was investigated in several studies on patients with metastatic breast cancer (MBC); and 26-.

Materials and Methods

Operation procedure

Treatment procedure and response evaluation

Results