Management of Breast Cancer Brain Metastases

Abstract

Fellow in Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, 2010 E 90th St, Cleveland, OH 44195, USA Director of Breast Oncology Program, Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA *Author for correspondence: Tel.: +1 216 445 0150; Fax: +1 216 444 9464; abrahaj5@ccf.org In 2014, an estimated 232,760 women will be diagnosed with breast cancer (BC) in the USA, and approximately 40,000 will die from the disease [1]. The incidence of brain metastases (BM) from BC is approximately 5% [2,3], and the number increases to 10–16% among women with stage IV BC [4,5]. However, these figures still underestimated the disease burden, with up to 30% of BC patients found to have BM at autopsy [6,7]. Among breast cancer brain metastasis (BCBM) patients, parenchymal BM are more common than leptomeningeal involvement with the latter being reported about 5 to 16% of patients at autopsy [8]. Management of BCBM remains a clinically unmet need with few therapeutic options or clinical trials. Improvements in systemic treatment increased survival of BC patients, and unmasked a subpopulation with BM that may significantly impair patient’s life quality and survival. Unique challenges in managing BCBM patients lie in overcoming blood–brain barrier (BBB) and resistance to multiple lines of prior treatment since patients in this setting are typically pretreated [9]. Recently, better characterization of BCBM patients, development of new systemic therapy along with improvements in trial design and imaging modalities regenerated an interest in developing novel agents for BCBM patients.