Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer

After the introduction of trastuzumab, a monoclonal antibody that binds to human epidermal growth factor receptor 2 (HER2), the overall survival (OS) among patients with HER2-positive breast cancer has been substantially improved. However, among these patients, the incidence of brain metastases (BM)...

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Autores principales:	Peng Yuan, Song-Lin Gao
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2017
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b7d0348f3a6843e9a2eea76808764af7
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spelling	oai:doaj.org-article:b7d0348f3a6843e9a2eea76808764af72021-12-02T14:38:54ZManagement of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer2095-882X10.1016/j.cdtm.2017.01.004https://doaj.org/article/b7d0348f3a6843e9a2eea76808764af72017-03-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095882X16300883https://doaj.org/toc/2095-882XAfter the introduction of trastuzumab, a monoclonal antibody that binds to human epidermal growth factor receptor 2 (HER2), the overall survival (OS) among patients with HER2-positive breast cancer has been substantially improved. However, among these patients, the incidence of brain metastases (BM) has been increasing and an increased proportion of them have died of intracranial progression, which makes HER2-positive breast cancer brain metastases (BCBM) a critical issue of concern. For local control of limited BM, stereotactic radiosurgery (SRS) and surgical resection are available modalities with different clinical indications. Postoperative or preoperative radiation is usually delivered in conjunction with surgical resection to boost local control. Adjuvant whole-brain radiotherapy (WBRT) should be deferred for limited BM because of its impairment of neurocognitive function while having no benefit for OS. Although WBRT is still the standard treatment for local control of diffuse BM, SRS is a promising treatment for diffuse BM as the technique continues to improve. Although large molecules have difficulty crossing the blood brain barrier, trastuzumab-containing regimens are critical for treating HER2-positive BCBM patients because they significantly prolong OS. Tyrosine kinase inhibitors are more capable of crossing into the brain and they have been shown to be beneficial for treating BM in HER2-positive patients, especially lapatinib combined with capecitabine. The antiangiogenic agent, bevacizumab, can be applied in the HER2-positive BCBM scenario as well. In this review, we also discuss several strategies for delivering drugs into the central nervous system and several microRNAs that have the potential to become biomarkers of BCBM. Keywords: Breast cancer brain metastases, Human epidermal growth factor receptor 2-positive breast cancer, Local control, Targeted therapy, MicroRNAPeng YuanSong-Lin GaoKeAi Communications Co., Ltd.articleMedicine (General)R5-920ENChronic Diseases and Translational Medicine, Vol 3, Iss 1, Pp 21-32 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Peng Yuan Song-Lin Gao Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
description	After the introduction of trastuzumab, a monoclonal antibody that binds to human epidermal growth factor receptor 2 (HER2), the overall survival (OS) among patients with HER2-positive breast cancer has been substantially improved. However, among these patients, the incidence of brain metastases (BM) has been increasing and an increased proportion of them have died of intracranial progression, which makes HER2-positive breast cancer brain metastases (BCBM) a critical issue of concern. For local control of limited BM, stereotactic radiosurgery (SRS) and surgical resection are available modalities with different clinical indications. Postoperative or preoperative radiation is usually delivered in conjunction with surgical resection to boost local control. Adjuvant whole-brain radiotherapy (WBRT) should be deferred for limited BM because of its impairment of neurocognitive function while having no benefit for OS. Although WBRT is still the standard treatment for local control of diffuse BM, SRS is a promising treatment for diffuse BM as the technique continues to improve. Although large molecules have difficulty crossing the blood brain barrier, trastuzumab-containing regimens are critical for treating HER2-positive BCBM patients because they significantly prolong OS. Tyrosine kinase inhibitors are more capable of crossing into the brain and they have been shown to be beneficial for treating BM in HER2-positive patients, especially lapatinib combined with capecitabine. The antiangiogenic agent, bevacizumab, can be applied in the HER2-positive BCBM scenario as well. In this review, we also discuss several strategies for delivering drugs into the central nervous system and several microRNAs that have the potential to become biomarkers of BCBM. Keywords: Breast cancer brain metastases, Human epidermal growth factor receptor 2-positive breast cancer, Local control, Targeted therapy, MicroRNA
format	article
author	Peng Yuan Song-Lin Gao
author_facet	Peng Yuan Song-Lin Gao
author_sort	Peng Yuan
title	Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
title_short	Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
title_full	Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
title_fullStr	Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
title_full_unstemmed	Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer
title_sort	management of breast cancer brain metastases: focus on human epidermal growth factor receptor 2-positive breast cancer
publisher	KeAi Communications Co., Ltd.
publishDate	2017
url	https://doaj.org/article/b7d0348f3a6843e9a2eea76808764af7
work_keys_str_mv	AT pengyuan managementofbreastcancerbrainmetastasesfocusonhumanepidermalgrowthfactorreceptor2positivebreastcancer AT songlingao managementofbreastcancerbrainmetastasesfocusonhumanepidermalgrowthfactorreceptor2positivebreastcancer
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Management of breast cancer brain metastases: Focus on human epidermal growth factor receptor 2-positive breast cancer

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