36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 77-78

36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists

36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists

Background/Significance

The management of HER2-positive breast cancer brain metastases is rapidly evolving as data with novel targeted therapies emerge, requiring clinicians to reevaluate their clinical approaches. This survey aimed to document current practices of breast cancer specialists regarding breast cancer brain metastases screening, monitoring, and treatment in this population to assess how these data are shaping contemporary clinical decision-making.

Materials and Methods

An international cohort of 32 clinicians with expertise in breast cancer brain metastases were invited via email to complete a 26-item survey from September to October 2024. Data were aggregated and analyzed to be utilized within a continuing medical education (CME) activity. Respondents were compensated for their participation.

Results

The 32 respondents practiced in the US (56%) and European Union (43%). Sixty percent of EU respondents reported their institution supports routine brain metastases screening in some or all patients with metastatic breast cancer compared with 0% of US-based institutions. However, more than half of all respondents (65%) agreed with EANO-ESMO guidelines that support brain metastases screening for all newly diagnosed patients with HER2-positive metastatic breast cancer. When presented with a case study examining a patient with newly identified HER2-positive breast cancer brain metastases after 12 months of trastuzumab, pertuzumab, and docetaxel (THP) therapy for which the extent of intracranial disease precluded use of local therapy other than whole-brain radiation, the top therapeutic selections were trastuzumab deruxtecan (53%) and whole-brain radiation followed by continued THP (16%) or a switch in systemic therapy (16%). Only 3% of respondents selected tucatinib plus capecitabine and trastuzumab. Nearly all respondents (91%) reported that they would be more inclined to offer systemic therapy in lieu of local therapy for a patient with newly diagnosed, HER2-positive breast cancer brain metastases. However, in patients with more significant disease burden, participants were divided between stereotactic radiosurgery and trastuzumab deruxtecan as their first step. Half of respondents (50%) indicated that their institutions have a specific care coordination program for patients with breast cancer brain metastases and/or caregivers.

Conclusion

While survey results reveal heterogeneity among specialists regarding the risks/benefits of early brain metastases screening in patients with breast cancer, more respondents favored the EANO-ESMO approach. Experts also were likely to consider novel systemic therapies over local treatment in patients with newly diagnosed HER2-positive breast cancer brain metastases. Further assessment of expert preferences is needed as data evolves.

Articles in this issue

2 Preventive Care and Screening Adherence Among Women Surviving Breast Cancer
2 Preventive Care and Screening Adherence Among Women Surviving Breast Cancer
3 Intraoperative Radiotherapy: Alive and Well in the Bronx
3 Intraoperative Radiotherapy: Alive and Well in the Bronx
4 Evaluating AI-Driven Responses in Breast Reconstruction: A Comparative Study of Response Formats
4 Evaluating AI-Driven Responses in Breast Reconstruction: A Comparative Study of Response Formats
5 Correlation Between Visual Impairment and Breast Cancer: A Cross-Sectional Study Based on the National Health Interview Surveys
5 Correlation Between Visual Impairment and Breast Cancer: A Cross-Sectional Study Based on the National Health Interview Surveys
6 Peer Support Programming Among Women At-Risk for Surviving Breast Cancer: Facilitators and Barriers to Community-Based Patient Navigation and the Role of Quality of Life
6 Peer Support Programming Among Women At-Risk for Surviving Breast Cancer: Facilitators and Barriers to Community-Based Patient Navigation and the Role of Quality of Life
7 Metaplastic Breast Cancer: A Retrospective Chart Review of Clinical Features
7 Metaplastic Breast Cancer: A Retrospective Chart Review of Clinical Features
8 A Case Series Exploring Characteristics and Outcomes of Metachronous Primary Breast and Lung Cancer in a Diverse Cohort
8 A Case Series Exploring Characteristics and Outcomes of Metachronous Primary Breast and Lung Cancer in a Diverse Cohort
9 Body Mass Index, Cancer Risk Behaviors, and Readiness for Dietary Change Among Women Surviving With Breast Cancer
9 Body Mass Index, Cancer Risk Behaviors, and Readiness for Dietary Change Among Women Surviving With Breast Cancer
10 AI as a Bridge: Can ChatGPT Help Patients Understand Their Breast Radiology Reports?
10 AI as a Bridge: Can ChatGPT Help Patients Understand Their Breast Radiology Reports?
12 Gut Microbiome Composition and Pathological Complete Response After Chemotherapy in Breast Cancer: Insights From a Pilot Study
12 Gut Microbiome Composition and Pathological Complete Response After Chemotherapy in Breast Cancer: Insights From a Pilot Study
13 Preliminary Analysis of Change During Treatment of Financial Toxicity and Quality of Life in Breast Cancer Patients
13 Preliminary Analysis of Change During Treatment of Financial Toxicity and Quality of Life in Breast Cancer Patients
15 Utilizing Circulating Tumor Cells to Guide HER2-Directed Therapy in IHC/FISH-Negative HER2+ Metastatic Breast Cancer
15 Utilizing Circulating Tumor Cells to Guide HER2-Directed Therapy in IHC/FISH-Negative HER2+ Metastatic Breast Cancer
16 A Miami Hospital’s Infrastructure to Help Decrease Late-Stage Breast Cancer Diagnosis and Improve Health Equity
16 A Miami Hospital’s Infrastructure to Help Decrease Late-Stage Breast Cancer Diagnosis and Improve Health Equity
17 Salmonella and the Breast: A Literature Review of Salmonella-Induced Breast Abscesses
17 Salmonella and the Breast: A Literature Review of Salmonella-Induced Breast Abscesses
18 Tolerability of First-Line Treatment With Ribociclib for Metastatic Breast Cancer Using 2 Large US Data Sources
18 Tolerability of First-Line Treatment With Ribociclib for Metastatic Breast Cancer Using 2 Large US Data Sources
Recent Videos
“The trial will be successful, or [we’ll] declare it a success if we see at least 3 of 24 responses overall,” stated Ravi, MD, BChir, MRCP, on the phase 2 LASER trial in RCC.
Success with the 177Lu-PSMA-617 radioligand therapy would be transformative for the clear cell renal cell carcinoma treatment landscape.
An ongoing phase 1 trial seeks to prove XmAb819 as an effective treatment and ENPP3 as a plausible target in patients with relapsed or refractory RCC.
“The therapy is designed to prevent both CAR T-cell inactivation and to restore the anti-tumor immunity of the white blood cells that have gotten through the tumor,” said Marasco, MD, PhD.
Ongoing studies aim to combine base immunotherapy regimens with novel agents to potentially improve outcomes among patients with kidney cancer.
Investigators have found a way to reduce liver and biliary toxicity when targeting the molecule CAIX in patients with clear cell renal cell carcinoma.
Neoantigen-targeting vaccines resulted in an absence of recurrence in 9 patients with high-risk kidney cancer, according to David A. Braun, MD, PhD.
The Kidney Cancer Research Consortium may allow collaborators to form more mechanistic and scientifically driven efforts in the field.
Wayne A. Marasco, MD, PhD, stated that by targeting 2 molecules instead of 1, higher levels of tumor cell killing can be achieved in patients with clear cell renal cell carcinoma.
Leading experts in the breast cancer field highlight the use of CDK4/6 inhibitors, antibody-drug conjugates, and other treatment modalities.
Related Content