Abstract
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+.
Publication Date
11-21-2024
Content Type
Article
PubMed ID:
Citation
Khatri, V. M., Mestres-Villanueva, M. A., Yarlagadda, S., Doniparthi, A., Smith, D. B., Nakashima, J. Y., Bryant, J. M., Zhao, D., Upadhyay, R., Mills, M. N., Oliver, D. E., Yu, H. M., Palmer, J. D., Williams, N. O., Mahtani, R. L., Ahluwalia, M. S., Soliman, H. H., Han, H. S., Soyano, A. E., Kim, Y., … Ahmed, K. A. (2024). Multi-institutional report of trastuzumab deruxtecan and stereotactic radiosurgery for HER2 positive and HER2-low breast cancer brain metastases. NPJ breast cancer, 10(1), 100. https://doi.org/10.1038/s41523-024-00711-w
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