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Management of brain metastases in breast cancer: a review of current practices and emerging treatments

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Abstract

Purpose

Breast cancer brain metastases (BCBM) are becoming an increasingly common diagnosis due to improved systemic control and more routine surveillance imaging. Treatment continues to require a multidisciplinary approach managing systemic and intracranial disease burden. Although, improvements have been made in the diagnosis and management of BCBM, brain metastasis patients continue to pose a challenge for practitioners.

Methods

In this review, a group of medical oncologists, radiation oncologists, radiologists, breast surgeons, and neurosurgeons specializing in the treatment of breast cancer reviewed the available published literature and compiled a comprehensive review on the current state of BCBM.

Results

We discuss the pathogenesis, epidemiology, diagnosis, treatment options (including systemic, surgical, and radiotherapy treatment modalities), and treatment response evaluation for BCBM. Furthermore, we discuss the ongoing prospective trials enrolling BCBM patients and their biologic rationale.

Conclusions

BCBM management is an increasing clinical concern. Multidisciplinary management combining the strengths of surgical, systemic, and radiation treatment modalities with prospective trials incorporating knowledge from the basic and translational sciences will ultimately lead to improved clinical outcomes for BCBM patients.

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Correspondence to Kamran A. Ahmed.

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Hsiang-Hsuan Michael Yu has received spearker’s honoraria from BrainLab and is on the advisory boards of Novocure and Abbvie. Michael A. Vogelbaum has indirect equity and royalty interests in Infuseon Therapeutics, Inc. and has received honoraria from Tocagen, Inc. and Celgene. Hatem Soliman serves as a consultant for Astrazeneca, Celgene, Novartis, PUMA, and Eisai. Brian J. Czerniecki has intellectual property on a HER2 dendritic cell vaccine. Peter A. Forsyth has received research funding from Pfizer and Celgene and is on the advisory boards of Novocure, BTG, Inovio, AbbVie, Ziopharm, Tocagen, and Pfizer. Hyo S. Han declares that she has received a speaker’s honorarium from Lilly Pharmaceuticals, research funding to the institution from Abbvie, Tesaro, TapImmune, Novartis, Bristol-Myers Squibb, Pfizer, SeattleGenetics, Prescient, Horizon, and Karyopharm. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb and Genentech.

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Mills, M.N., Figura, N.B., Arrington, J.A. et al. Management of brain metastases in breast cancer: a review of current practices and emerging treatments. Breast Cancer Res Treat (2020). https://doi.org/10.1007/s10549-020-05552-2

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Keywords

  • Breast cancer brain metastases
  • Stereotactic radiation
  • Immunotherapy
  • Blood–brain barrier
  • Blood-tumor barrier