Multi-institutional report of trastuzumab deruxtecan and stereotactic radiosurgery for HER2 positive and HER2-low breast cancer brain metastases
Trastuzumab-deruxtecan (T-DXd) has demonstrated intracranial efficacy; however, safety and efficacy data remains limited with stereotactic radiosurgery (SRS). A multi-institutional review was performed with HER2+ or HER2-low metastatic breast cancer treated with T-DXd and SRS for active brain metastases. We identified 215 lesions treated over 48 SRS courses in 34 patients. Median follow up from T-DXd initiation was 13.9 months. The cumulative incidence of symptomatic radiation necrosis at 24 months per lesion was 2.1% and per patient 11%. The 12-month LC was 97%. HER2-low was associated with worse distant intracranial control (DIC) (adjusted HR 2.5, 95% CI 1.1-5.6, p = 0.03) and worse systemic progression free survival (PFS) (HR 4.1, 95% CI 1.6-10.7, p = 0.004). Concurrent SRS and T-DXd has excellent local control, without an increased risk of radiation necrosis. HER2-low disease is associated with worse systemic PFS and DIC with T-DXd compared to HER2+.
Authors
- Reshma Mahtani (ORCID: https://orcid.org/0000-0002-7711-8627)
- Daniel Oliver (ORCID: https://orcid.org/0000-0001-6755-9923)
- Aixa Soyano (ORCID: https://orcid.org/0000-0003-1506-5934)
- Sreenija Yarlagadda (ORCID: https://orcid.org/0000-0001-5203-7989)
- Rupesh Kotecha (ORCID: https://orcid.org/0000-0001-6927-0402)
- Rituraj Upadhyay (ORCID: https://orcid.org/0000-0003-4079-1268)
- Vaseem Khatri (ORCID: https://orcid.org/0009-0007-0891-6063)
- Manmeet S. Ahluwalia (ORCID: https://orcid.org/0000-0003-3794-9511)
- Joshua D. Palmer (ORCID: https://orcid.org/0000-0003-3311-0129)
- John Michael Bryant (ORCID: https://orcid.org/0000-0002-0207-1991)
- Ya-Yu Tsai (ORCID: https://orcid.org/0000-0002-0621-9519)
- Matthew N. Mills (ORCID: https://orcid.org/0000-0002-8483-105X)
- Mariella Mestres-Villanueva (ORCID: https://orcid.org/0000-0002-7130-1404)
- Hyo S. Han (ORCID: https://orcid.org/0000-0002-0072-0257)
- Kamran A. Ahmed (ORCID: https://orcid.org/0000-0003-3331-1529)
- Sasha Beyer (ORCID: https://orcid.org/0000-0001-5651-6581)
- Hatem Soliman (ORCID: https://orcid.org/0000-0001-6644-2264)
- Ajay Doniparthi (ORCID: https://orcid.org/0009-0009-2889-8063)
- Nicole Williams (ORCID: https://orcid.org/0000-0002-2213-0071)
- Dekuang Zhao (ORCID: https://orcid.org/0000-0002-7251-2481)
- Youngchul Kim (ORCID: https://orcid.org/0000-0002-2307-0330)
- David B. Smith
- Justyn Y. Nakashima
Institutions
- West Virginia University (US)
- Baptist Hospital of Miami (US)
- University of South Florida (US)
- The Ohio State University Wexner Medical Center (US)
- Moffitt Cancer Center (US)
- Baptist Health South Florida (US)
Publication Details
- Journal
- npj Breast Cancer
- Published
- 2024-11-21
- DOI
- https://doi.org/10.1038/s41523-024-00711-w
- Citations
- 14
- Primary Topic
- Brain Metastases and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 5.87