The evolving role of trastuzumab emtansine (T-DM1) in HER2-positive breast cancer with brain metastases

• Published in: Critical reviews in oncology/hematology 2019-11, Vol.143, p.20-26
• Main Authors: Dong, Rongrong, Ji, Jiali, Liu, Hong, He, Xuexin
• Format: Article
• Language: English
• Subjects: Ado-Trastuzumab Emtansine - pharmacology; Ado-Trastuzumab Emtansine - therapeutic use; Antineoplastic Agents, Immunological - pharmacology; Antineoplastic Agents, Immunological - therapeutic use; Brain metastases; Brain Neoplasms - drug therapy; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - enzymology; Breast Neoplasms - pathology; Female; HER2; Humans; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Receptor, ErbB-2 - metabolism; Trastuzumab emtansine (TDM1)
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2019.07.010

•HER2 overexpression is a risk factor for brain metastases.•Systemic therapies may not exert efficacious function on breast cancer with brain metastases.•T-DM1 which is a novel HER2-targeted is identified effective for HER2-positive breast cancer with brain metastases in clinical practice.•This article provides an up-to-date account stating the current position relating to the managements of breast cancer with brain metastases and highlights new insights into tackling the problem especially in relation to T-DM1. Approximately 30–50% of advanced human epidermal growth factor receptor 2 (HER2) positive breast cancer patients will develop brain metastases (BMs) during the disease course. Brain metastases may become a main limitation of life expectancy and a half of them will die from brain progression. Even in patients with early HER2-positive breast cancer managed with curative therapy, the risk of brain metastases is also increased. Central nervous system (CNS) may usually present as the first site of recurrence in HER2-positive breast cancer. Local treatments including radiotherapy and surgery are essential while new chemotherapy and biological agents appear to contribute a significant role in the future treatment field of CNS metastases. This article will review recent progresses in HER2-positive breast cancer with BM, with a focus on the efficacy of the HER2 targeted agents-trastuzumab emtansine (T-DM1).