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| |  SABCS: Herceptin (Trastuzumab) Spares Bone from Metastasis but Leaves Brain Unprotected By Robert H. Carlson SAN ANTONIO, TX -- December 13, 2001 -- Patients with metastatic breast cancer who receive gene therapy with the monoclonal antibody Herceptin (trastuzumab) appear to be at increased risk for subsequent development of brain metastasis compared to bone metastasis. This most likely occurs because Herceptin, while adequately treating systemic metastases, does not cross the blood-brain barrier and is inadequate treatment of brain metastases. The brain is known to be a sanctuary site for metastatic tumor cells in several different malignancies. It is known that patients with metastatic breast cancer are more likely to develop bone rather than brain metastasis, said principal investigator Elyse E. Lower, MD, from the Department of Hematology/Oncology, University of Cincinnati Medical Center, in Cincinnati, Ohio. Dr. Lower and colleagues conducted a study to determine the incidence of brain metastasis in patients receiving Herceptin compared to those not receiving Herceptin. During a poster presentation at the 24th Annual San Antonio Breast Cancer Symposium, Robin Blau, RN, and research nurse on this study, said data were analyzed on 182 women with metastatic disease who never received Herceptin and 45 women who did receive the drug. Women who never received Herceptin were more likely to develop bone metastasis (160 of 182) than brain metastasis (60 of 182) (p<0.00001). Eleven of 39 patients (28 percent) who did not have brain metastasis at the start of Herceptin therapy subsequently developed brain metastasis while receiving therapy. Dr. Lower said that in contrast, about 10 percent of patients with advanced breast cancer would be expected to develop brain metastases without Herceptin therapy. One of the 23 patients (4 percent) without bone metastasis at the start of Herceptin therapy subsequently developed bone metastasis on therapy (p<0.05). The time from initiation of Herceptin to development of brain and bone metastasis was compared using a log rank analysis of Kaplan-Meier curves, which revealed that brain metastasis developed earlier than did bone metastasis (p<0.02). "I think this happens because Herceptin is good at protecting against other systemic metastases, in the bone for example, but it leaves the brain untreated and so people are developing more [central nervous system] disease," Dr. Lower said. She said this is very similar to what occurs in small cell lung cancer, in that the usual cytotoxic drugs do not cross the blood-brain barrier, and many patients have developed brain metastasis. Dr. Lower said her study raises the question of whether brain irradiation should be considered for patients who are responding well to Herceptin and are close to or in remission.
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