BACKGROUND: In the last 10 years, multiple new targeted agents have been developed for patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Up to 55% of patients with HER2+ breast cancer will develop brain metastases requiring some form of radiation therapy. The interaction between radiation and these targeted agents is unknown and previously unreported. METHODS: In this series, we describe 4 patients who developed clinically significant brain edema at sites of treated brain metastases. These patients were treated with stereotactic radiosurgery and trastuzumab emtansine, the newest FDA-approved agent for metastatic HER2+ breast cancer. Additionally, we present rates of clinically significant radiation necrosis among all breast cancer patients treated during this same time period. RESULTS: Using previously published clinical and preclinical data, we then hypothesize possible mechanisms for this striking interaction. CONCLUSION: Increased awareness of potential interactions between targeted agents and radiation to the brain is crucial.
BACKGROUND: In the last 10 years, multiple new targeted agents have been developed for patients with humanepidermal growth factor receptor 2-positive (HER2+) breast cancer. Up to 55% of patients with HER2+ breast cancer will develop brain metastases requiring some form of radiation therapy. The interaction between radiation and these targeted agents is unknown and previously unreported. METHODS: In this series, we describe 4 patients who developed clinically significant brain edema at sites of treated brain metastases. These patients were treated with stereotactic radiosurgery and trastuzumab emtansine, the newest FDA-approved agent for metastatic HER2+ breast cancer. Additionally, we present rates of clinically significant radiation necrosis among all breast cancerpatients treated during this same time period. RESULTS: Using previously published clinical and preclinical data, we then hypothesize possible mechanisms for this striking interaction. CONCLUSION: Increased awareness of potential interactions between targeted agents and radiation to the brain is crucial.
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