AN INCREASING number of women suffering from advanced breast cancer are developing secondary brain tumours, but a new treatment could spare them from having to undergo debilitating neurological side effects of whole brain radiotherapy (WBRT).

New research published in The Lancet Oncology shows that if cancer has spread to the brain, it could be effectively treated systemically with a combination of two drugs – lapatinib and capecitabine – producing similar response rates to WBRT.

The treatment was shown to shrink brain tumours by at least 50 per cent in two-thirds of women with advanced HER2-positive breast cancer, with a fifth of patients experiencing at least 80 per cent reduction in tumour size, but with manageable side effects.

Women now live longer with advanced cancer

“As women live longer with advanced cancer the occurrence of brain metastases is becoming increasingly common,” Thomas Bachelot from the Centre Léon Bérard in Lyon, France.

Currently, 20 per cent to 30 per cent of women with advanced breast cancer develop secondary brain tumours. Those with HER2-positive disease appear to be most at risk, with up to half developing brain metastases, Bachelot explained. “Traditionally, most of these women receive WBRT which can impair cognitive function. Delaying such a treatment for those patients is potentially a big advance.”

Forty-five patients – all with previously untreated brain metastases from HER2-positive breast cancer – were assessed as part of the study, conducted by the French cooperative group UNICANCER. The subjects were treated with a daily combination of lapatinib and capecitabine.

A total of 37 patients (84 per cent) experienced some reduction in brain tumour size from the start of the study, with tumours shrinking by 50 per cent or more in 29 women (66 per cent) and by at least 80 per cent in nine patients (20 per cent).

Side effects

Researchers described the side effects noted from the combination therapy as “predictable and manageable”, with about half of patients experiencing at least on grade 3 or 4 side effect – the most common being diarrhoea and hand-foot syndrome. Four women discontinued the treatment due to such side effects.

Bachelot said that median time to WBRT was 8.3 months, which he said was “particularly relevant for a population with short overall survival, and could help delay the substantial toxicities of radiotherapy”. He recommended that the treatment undergo further evaluation to confirm the clinical benefits in terms of “survival, cognitive function, and quality of life.”

Similarly, Rupert Bartsch and Matthias Preusser of the Medical University of Vienna in Austria expressed hope that the treatment that could spare some women from radiotherapy.

“For patients with multiple brain metastases from HER2-positive breast cancer presenting with minimal clinical symptoms and good performance status, primary systemic treatment containing lapatinib and capecitabine might already be a valid treatment option,” they commented.

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