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09.08.2019 | Clinical Study

CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases

verfasst von: Nicholas B. Figura, Thrisha K. Potluri, Homan Mohammadi, Daniel E. Oliver, John A. Arrington, Timothy J. Robinson, Arnold B. Etame, Nam D. Tran, James K. Liu, Hatem Soliman, Peter A. Forsyth, Solmaz Sahebjam, H. Michael Yu, Hyo S. Han, Kamran A. Ahmed

Erschienen in: Journal of Neuro-Oncology | Ausgabe 3/2019

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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.

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Titel: CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases
verfasst von: Nicholas B. Figura
Thrisha K. Potluri
Homan Mohammadi
Daniel E. Oliver
John A. Arrington
Timothy J. Robinson
Arnold B. Etame
Nam D. Tran
James K. Liu
Hatem Soliman
Peter A. Forsyth
Solmaz Sahebjam
H. Michael Yu
Hyo S. Han
Kamran A. Ahmed
Publikationsdatum: 09.08.2019
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 3/2019
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-019-03260-6

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