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- Title
CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases.
- Authors
Figura, Nicholas B.; Potluri, Thrisha K.; Mohammadi, Homan; Oliver, Daniel E.; Arrington, John A.; Robinson, Timothy J.; Etame, Arnold B.; Tran, Nam D.; Liu, James K.; Soliman, Hatem; Forsyth, Peter A.; Sahebjam, Solmaz; Yu, H. Michael; Han, Hyo S.; Ahmed, Kamran A.
- Abstract
Purpose: Cyclin-dependent kinase (CDK) 4/6 inhibitors are becoming increasingly utilized in the setting of advanced, hormone receptor (HR+) positive breast cancer. Pre-clinical data suggests a potential synergy between radiation therapy (RT) and CDK4/6 inhibitors. We assessed clinical outcomes of patients treated at our institution with the use of CDK4/6 inhibitors and stereotactic radiation in the management of HR+ breast brain metastases. Methods: A retrospective analysis of patients who received stereotactic radiotherapy for HR+ brain metastases within 6 months of CDK4/6 inhibitor administration was performed. The primary endpoint was neurotoxicity during or after stereotactic radiation. Secondary endpoints were local brain control, distant brain control, and overall survival (OS). Results: A total of 42 lesions treated with stereotactic radiation in 15 patients were identified. Patients received either palbociclib (n = 10; 67%) or abemaciclib (n = 5; 33%). RT was delivered concurrently, before, or after CDK4/6 inhibitors in 18 (43%), 9 (21%), and 15 (36%) lesions, respectively. Median follow-up following stereotactic radiation was 9 months. Two lesions (5%) developed radionecrosis, both of which received four prior RT courses to the affected lesion prior to onset of radionecrosis and subsequently managed with steroids and bevacizumab. Six- and 12-month local control of treated lesions was 88% and 88%, while 6- and 12-month distant brain control was 61% and 39%, respectively. Median OS was 36.7 months from the date of brain metastases diagnosis. Conclusions: Stereotactic radiation to breast brain metastases was well tolerated alongside CDK4/6 inhibitors. Compared to historical data, brain metastases control rates are similar whereas survival appears prolonged.
- Subjects
METASTATIC breast cancer; HORMONE receptor positive breast cancer; BRAINWASHING; BRAIN metastasis
- Publication
Journal of Neuro-Oncology, 2019, Vol 144, Issue 3, p583
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-019-03260-6