Dr Sammons on Treating Patients With Breast Cancer Who Present With Brain Metastases

Sarah Sammons, MD, medical oncologist, clinical investigator, the Breast Oncology Center, associate director, Metastatic Breast Cancer Program, Dana-Farber Cancer Institute, discusses the goals of treating patients with breast cancer who present with active vs stable brain metastasis.

Clinical trials involving patients with brain metastases often categorize patients as having stable or active metastases, Sammons begins. Stable brain metastases have typically undergone local regional therapies, such as radiation, possibly combined with resection for solitary lesions, resulting in metastases stability on subsequent scans, she states. Conversely, active brain metastases are defined as those that are either untreated or are treated with local modalities, such as radiation, but continue to progress, Sammons explains.

The overarching goals for treating all brain metastases remain consistent: alleviating neurologic symptoms, preventing neurologic death, hindering the occurrence or progression of metastases, and enhancing overall survival and quality of life, she emphasizes. However, treatment approaches vary based on the stability of the brain metastases, Sammons expands. For stable brain metastases, local modalities, such as radiation, prove highly effective, she says. The treatment focus in these cases is on prolonging central nervous system (CNS) progression-free survival, aiming to delay the onset of another CNS event, whether it be the growth of a previously radiated metastasis or the emergence of new lesions, Sammons notes, adding that this is primarily achieved through systemic therapies.

Conversely, patients with active brain metastases may have multiple lesions, often exceeding 6 or 10 lesions, and may be deferring whole-brain radiation therapy. In such cases, the key treatment objective is intracranial control, Sammons continues, with an emphasis on identifying systemic therapies with well-established intracranial activity and a high response rate. This is crucial for rapidly shrinking lesions and effectively managing brain disease, especially when patients are delaying local therapy or facing progression after inadequate local treatment, Sammons states. A swift response in the brain is imperative in these situations, she concludes.