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Progress in the Treatment of Brain Mets

Posted 6/20/2013

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  For many of us, the mere thought of brain mets is terrifying. Many women have told me that this is their biggest fear, that is feels even worse than thinking about the possibility of mets to other important body parts . Certainly we "live" in our brains in a different way than we do in our livers, and the obvious impairments that can happen are very distressing. In the early years of working as an oncology social worker, brain mets pretty much lived up to their terrible reputation. If this happened, suffering ensued with death not so far behind. That is no longer true. Blessedly.

  From my non-physician perspective, it now generally seems that brain mets are no better and no worse than mets to another critical organ. They can be very well treated, and I know many women who have received radiation to the brain and have not had subsequent recurrence of disease in that area. Many of these women continue to work full time, travel, have close to normal lives (the "close to normal" reflects the reality that anyone with metastatic cancer is on some kind of treatment for the duration).

  This article from MedScape is an interview with two Boston oncologists, Lydia Schapira, MD at MGH and Nancy Lin, MD at DFCI. It is a very good summary of the current state of affairs vis a vis brain mets. Obviously, we all fervently hope that we never have to contend with this situation, but, if you do, please be a tiny bit less frightened and discouraged than you might have needed to be ten years ago.

Here is the beginning and then a link to read more:

Making Headway in Brain Metastases
Lidia Schapira, MD, Nancy U. Lin, MD

Can Bevacizumab Control Brain Metastases?

Dr. Schapira: Your work has homed in on central nervous system metastases in breast cancer, which is a growing problem as our systemic treatments become better. Were there presentations at this year's San Antonio Breast Cancer Symposium (SABCS) that addressed this problem? 

Dr. Lin: A poster presented by a group at Massachusetts General Hospital[1] looked at combined HER2 and vascular endothelial growth factor (VEGF) blockade in preclinical animal models and demonstrated a survival advantage for the combination. Although anti-VEGF-based therapies have certainly had their ups and downs in breast cancer, some special populations could benefit. There is some interest in targeting tumor angiogenesis to control brain metastases.

We recently completed a trial at Dana-Farber/Harvard Cancer Center looking at a bevacizumab-based regimen in patients with brain metastasis.[2] We are hoping to present the results in the next few months. We also participated in a study evaluating a blood/brain-permeable taxane, GRN1005. Hopes for this study were high on the basis of the strength of the phase 1 study.[3] However, in the interim analysis, although we saw some minor responses and there were some investigator-reported responses, no responses were confirmed by independent radiologic review. A fair number of patients still need to be analyzed for the final results, but the results were less favorable than the phase 1 data had led us to expect.

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