366P - Activity of T-DM1 in Her2-positive breast cancer brain metastases

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer agents
Breast Cancer
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Therapy
Biological Therapy
Presenter Rupert Bartsch
Citation Annals of Oncology (2014) 25 (suppl_4): iv116-iv136. 10.1093/annonc/mdu329
Authors R. Bartsch1, A.S. Berghoff1, U. Vogl2, M. Rudas3, E. Bergen1, M. Gnant4, K. Dieckmann5, K. Pinker-Domenig6, L. Oehler2, C. Zielinski7, G.G. Steger8, M. Preusser7
  • 1Department Of Medicine I, Clinical Division Of Medical Oncology, Medical University of Vienna, 1090 - Vienna/AT
  • 2Department Of Medicine, St. Joseph's Hospital, Vienna/AT
  • 3Pathology, Medical University of Vienna, 1090 - Vienna/AT
  • 4Deparment Of Surgery, Medical University of Vienna, 1090 - Vienna/AT
  • 5Radiation Oncology, Medical University of Vienna, Vienna/AT
  • 6Department Of Radiology, Medical University of Vienna, 1090 - Vienna/AT
  • 7Department Of Medicine I, Medical University of Vienna, 1090 - Vienna/AT
  • 8Department Of Medicine I/oncology, Medical University of Vienna, AT-1090 - Vienna/AT

Abstract

Aim

Local treatment options such as radiotherapy or neurosurgery are the mainstay of brain metastases (BM) management. Whole brain radiotherapy (WBRT), however, is associated with severe late-toxicity. The LANDSCAPE trial established lapatinib plus capecitabine (LapCap) as primary systemic treatment in oligosymptomatic patients (pts) with multiple Her2-positive BM. Limited evidence exists regarding the activity of antibodies in BM. T-DM1 is an antibody-drug conjugate covalently linking trastuzumab (T) to an anti-microtubule agent (emtansine) with higher activity and lower toxicity as compared to LapCap. Therefore, we evaluated the activity of T-DM1 in newly diagnosed BM or BM progressing after local initial treatment.

Methods

Nine pts (median age 55 years) with Her2-positive BM treated at two Austrian centres were included. All pts had received prior treatment with T, five pts (55.6%) had already received lapatinib, and two pts (22.2%) pertuzumab as well. In two asymptomatic pts, T-DM1 was administered as primary therapy, while seven pts had documented CNS progression upon prior local treatment. T-DM1 was administered every three weeks at a dose of 3.6 mg/kg.

Results

Median follow-up was 6 months and median brain metastases-free survival 11 months. Seven pts (two with primary treatment and five receiving T-DM1 upon CNS progression) are currently assessable for CNS response. 3/7 pts (42.9%) had a partial remission, one patient progressing upon prior local therapy had stable disease lasting for fifteen cycles, and one patient had stable disease for 5 month. Two pts with prior WBRT had CNS progression after three treatment cycles.

Conclusions

This prospective case series again indicates relevant clinical activity of systemic treatment in Her2-positive BM. LapCap remains the standard of care but results of this analysis warrants further investigation of T-DM1 in BM in the context of prospective clinical studies.

Disclosure

R. Bartsch: has received lecture honoraria, research grants and travel support from Roche Austria. R. Bartsch has received lecture honoraria from GSK Austria; M. Preusser: has received lecture honoraria and research support from Roche Austria.All other authors have declared no conflicts of interest.