Revisión

Avances en el manejo de las metástasis cerebrales por cáncer de mama

Carmen Hinojo Gonzalez, Lucía Andrea Alonso Buznego, Pablo Jara Martín

Prepublicado: 2023-07-12

Publicado: 2023-07-17

VOLUMEN 37, NÚM. 2, marzo-abril (2023), PAG. 98-104

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El cáncer de mama es la segunda causa más frecuente de metástasis cerebrales. Su incidencia ha aumentado en los últimos años, especialmente en las pacientes con tumores de mama triple negativo o HER2 positivo. La supervivencia varía ampliamente en función de una serie de factores pronósticos. El abordaje de las metástasis cerebrales en cáncer de mama diseminado requiere un manejo multidisciplinar, con cambios en los últimos años, que conducen a un mayor empleo del tratamiento sistémico y a la radioterapia estereotáctica (SRS). Disponemos de resultados especialmente prometedores con nuevos fármacos anti-HER2 y con conjugados anti cuerpo-fármaco (ADC). A pesar de la mejoría en los tratamientos, las metástasis cerebrales en cáncer de mama siguen siendo un reto terapéutico. Los esfuerzos se centran en su prevención, su diagnóstico precoz y en la búsqueda de tratamientos eficaces.

Palabras Clave: Cáncer de mama avanzado. Metástasis cerebrales. Sistema nervioso central (SNC).

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Kuksis, M.; Gao, Y.; Tran, W., et al. The incidence of brain metastases among patients with metastatic breast cancer: a systematic review and meta-analysis. Neuro Oncol. 2021. Jun 1;23(6):894-904.
DOI: 10.1093/neuonc/noaa285

Komorowski, AS.; Warner, E.; MacKay, H.J.; et al. Incidence of brain metastases in non-metastatic and metastatic breast cancer: is there a role for screening?, Clin Breast Cancer. 2020;20(1):e54-e64.
DOI: 10.1016/j.clbc.2019.06.007

Gennari, A.; Pusztai, L.; Barrios, C.; Cortés, J. C.; De Azambuja, E.; DeMichele, A.; Dent, R.; Fenlon, D.; Gligorov, J.; Hurvitz, S. A.; Im, S.; Krug, D.; Kunz, W. S.; Loi, S.; Penault-Llorca, F.; Ricke, J.; Robson, M. E.; Rugo, H. S.; Saura, C.; . . . Harbeck, N. (2021). ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Annals of Oncology, 32(12), 1475-1495. https://doi.org/10.1016/j.annonc.2021.09.019
DOI: 10.1016/j.annonc.2021.09.019

Sperduto, P. W.; Mesko, S.; Li, J. ; Cagney, D. ; Aizer, A. ; Lin, N. U. ; Nesbit, E. ; Kruser, T. J. ; Chan, J. ; Braunstein, S. ; Lee, J. ; Kirkpatrick, J. P. ; Breen, W. ; Brown, P. D. ; Shi, D. ; Shih, H. A. ; Soliman, H. ; Sahgal, A. ; Shanley, R. ; . . . Mehta, M. P. (2020). Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today. International Journal of Radiation Oncology*Biology*Physics, 107(2), 334-343. https://doi.org/10.1016/j.ijrobp.2020.01.051
DOI: 10.1016/j.ijrobp.2020.01.051

Mampre, D. ; Mehkri, Y. ; Rajkumar, S. ; Sriram, S. ; Hernandez, J. E. ; Lucke-Wold, B. & Chandra, V. (2022). Treatment of breast cancer brain metastases: radiotherapy and emerging preclinical approaches. Diagnostics and Therapeutics, 23-36. https://doi.org/10.55976/dt.1202216523-36
DOI: 10.55976/dt.1202216523-36

Le Rhun, E.; Guckenberger, M. ; Smits, M. ; et al. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol. 2021 Nov; 32(11):1332-1347
DOI: 10.1016/j.annonc.2021.07.016

Kalkanis, S. N. ; Kondziolka, D. ; Gaspar, L. E. ; Burri, S. H. ; Asher, A. L. ; Cobbs, C. ; Ammirati, M. ; Robinson, P. D. ; Andrews, D. L. ; Loeffler, J. S. ; McDermott, M. W. ; Mehta, M. P. ; Mikkelsen, T. ; Olson, J. J. ; Paleologos, N. ; Patchell, R. A. ; Ryken, T. C. ; & Linskey, M. E. (2010). The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. Journal of Neuro-oncology, 96(1), 33-43. https://doi.org/10.1007/s11060-009-0061-8
DOI: 10.1007/s11060-009-0061-8

Li, J. C. ; Ludmir, E. B. ; Wang, Y. ; Guha-Thakurta, N. ; McAleer, M. ; Settle, S. H. ; Yeboa, D. N. ; Ghia, A. J. ; McAleer, M. F. ; Chung, C. Y. ; Woodhouse, K. D. ; Briere, T. M. ; Sullaway, C. ; Liu, D. ; Rao, G. P. ; Chang, E. ; Mahajan, A. V. ; Sulman, E. M. ; Brown, P. & Wefel, J. P. (2020). Stereotactic Radiosurgery versus Whole-brain Radiation Therapy for Patients with 4-15 Brain Metastases: A Phase III Randomized Controlled Trial. International Journal of Radiation Oncology Biology Physics, 108(3), S21-S22. https://doi.org/10.1016/j.ijrobp.2020.07.2108
DOI: 10.1016/j.ijrobp.2020.07.2108

Kim, Y. S.; Cho, K. H. ; Kim, J. S. ; Lim, Y. J. ; Min, H. S. ; Lee, S. ; Kim, H. ; Gwak, H. ; Yoo, H. & Lee, S. H. (2010). Single-Dose Versus Fractionated Stereotactic Radiotherapy for Brain Metastases. International Journal of Radiation Oncology Biology Physics, 81(2), 483-489. https://doi.org/10.1016/j.ijrobp.2010.05.033
DOI: 10.1016/j.ijrobp.2010.05.033

Gaspar, L. ; Scott, C. ; Rotman. M. ; Asbell, S. ; Phillips, T. ; Wasserman, T. ; McKenna, WG. ; Byhardt, R. (1997). Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. International Journal of Radiation Oncology Biology Physics, 37(4):745-51. https://doi.org/10.1016/s0360-3016(96)00619-0.
DOI: 10.1016/S0360-3016(96)00619-0

Gondi, V.; Pugh, S. L. ; Tomé, W. A. ; Caine, C. ; Corn, B. ; Kanner, A. A. ; Rowley, H. A., Kundapur, V., DeNittis, A. S., Greenspoon, J. S., Konski, A., Bauman, G., Shah, S. ; Shi, W. ; Wendland, M. M. ; Kachnic, L. A. & Mehta, M. P. (2014). Preservation of Memory With Conformal Avoidance of the Hippocampal Neural Stem-Cell Compartment During Whole-Brain Radiotherapy for Brain Metastases (RTOG 0933): A Phase II Multi-Institutional Trial. Journal of Clinical Oncology, 32(34), 3810-3816. https://doi.org/10.1200/jco.2014.57.2909
DOI: 10.1200/JCO.2014.57.2909

Avila, J., & Leone, J. P. (2022). Advances in the Management of Central Nervous System Metastases from Breast Cancer. International Journal of Molecular Sciences, 23(20), 12525. https://doi.org/10.3390/ijms232012525
DOI: 10.3390/ijms232012525

Hamester, F. ; Stürken, C. ; Saygi, C. ; Qi, M. ; Legler, K. ; Gorzelanny, C. ; Robador, J. R. ; Schmalfeldt, B. ; Laakmann, E. ; Müller, V. ; Witzel, I. & Oliveira-Ferrer, L. (2022). Insights into the Steps of Breast Cancer–Brain Metastases Development: Tumor Cell Interactions with the Blood–Brain Barrier. International Journal of Molecular Sciences, 23(3), 1900. https://doi.org/10.3390/ijms23031900
DOI: 10.3390/ijms23031900

Müller, V. ; Bartsch, R. ; Lin, N. U. ; Montemurro, F. ; Pegram, M. D. & Tolaney, S. M. (2023). Epidemiology, clinical outcomes, and unmet needs of patients with human epidermal growth factor receptor 2-positive breast cancer and brain metastases: A systematic literature review. Cancer Treatment Reviews, 115, 102527. https://doi.org/10.1016/j.ctrv.2023.102527
DOI: 10.1016/j.ctrv.2023.102527

Lin, N. ; Lueftner, D. ; Brufsky, A. ; Tolaney, S. M. ; Melisko, M. E. ; Holmes, F. A. & Awada, A. (2022). Abstract P2-13-05: Central nervous system metastases as a site of first recurrence in adjuvant therapy trials of HER2+ early breast cancer (EBC). Cancer Research, 82(4_Supplement), P2-05. https://doi.org/10.1158/1538-7445.sabcs21-p2-13-05
DOI: 10.1158/1538-7445.SABCS21-P2-13-05

Lin, N. ; Murthy, R. K. ; Abramson, V. ; Anders, C. ; Bachelot, T. ; Bedard, P. L. ; Borges, V. ; Cameron, D. ; Carey, L. A. ; Chien, A. J. ; Curigliano, G. ; DiGiovanna, M. P. ; Gelmon, K. ; Hortobagyi, G. ; Hurvitz, S. A. ; Krop, I. ; Loi, S. ; Loibl, S. ; Müller, V. ; Winer, E. P. (2022). Tucatinib vs Placebo, Both in Combination With Trastuzumab and Capecitabine, for Previously Treated ERBB2 (HER2)-Positive Metastatic Breast Cancer in Patients With Brain Metastases. JAMA Oncology, 9(2), 197. https://doi.org/10.1001/jamaoncol.2022.5610
DOI: 10.1001/jamaoncol.2022.5610

Cortes, J.; Kim, S. ; Chung, W. ; Im, S. ; Park, Y. H. ; Hegg, R. ; Kim, E. K. ; Tseng, L. ; Petry, V. ; Chung, C. ; Iwata, H. ; Hamilton, E. ; Curigliano, G. ; Xu, B. ; Huang, C. ; Kim, J. H. ; Chiu, J. ; Pedrini, J. L. ; Lee, C. ; . . . Hurvitz, S. A. (2022). Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer. The New England Journal of Medicine, 386(12), 1143-1154. https://doi.org/10.1056/nejmoa2115022
DOI: 10.1056/NEJMoa2115022

Bartsch, R. ; Preusser, M. ; Furtner, J. ; Marhold, M. ; Bergen, E. ; Roider-Schur, S. ; Starzer, A. M. ; Forstner, H. ; Rottenmanner, B. ; Dieckmann, K. ; Bago-Horvath, Z. ; Widhalm, G. ; Ilhan-Mutlu, A. ; Minichsdorfer, C. ; Fuereder, T. ; Singer, C. F. ; Weltermann, A. ; Puhr, R. & Preusser, M. (2022). 165MO Trastuzumab-deruxtecan (T-DXd) in HER2-positive breast cancer patients (pts) with active brain metastases: Primary outcome analysis from the TUXEDO-1 trial. Annals of Oncology, 33, S198. https://doi.org/10.1016/j.annonc.2022.03.184
DOI: 10.1016/j.annonc.2022.03.184

Krop, I. E. ; Lin, N. ; Blackwell, K. L. ; Guardino, E. ; Huober, J. ; Lu, M. ; Miles, D. ; Samant, M. G. ; Welslau, M. & Diéras, V. (2015). Trastuzumab emtansine (T-DM1) versus lapatinib plus capecitabine in patients with HER2-positive metastatic breast cancer and central nervous system metastases: a retrospective, exploratory analysis in EMILIA. Annals of Oncology, 26(1), 113-119. https://doi.org/10.1093/annonc/mdu486
DOI: 10.1093/annonc/mdu486

Petrelli, F.; Ghidini, M. ; Lonati, V. ; Tomasello, G. ; Borgonovo, K. ; Ghilardi, M. ; Cabiddu, M. & Barni, S. (2017). The efficacy of lapatinib and capecitabine in HER-2 positive breast cancer with brain metastases: A systematic review and pooled analysis. European Journal of Cancer, 84, 141-148. https://doi.org/10.1016/j.ejca.2017.07.024
DOI: 10.1016/j.ejca.2017.07.024

Syriac, A. K. ; Nandu, N. S. & Leone, J. P. (2022). Central Nervous System Metastases from Triple-Negative Breast Cancer: Current Treatments and Future Prospective. Breast cancer, Volume 14, 1-13. https://doi.org/10.2147/bctt.s274514
DOI: 10.2147/BCTT.S274514

Boogerd, W.; Dalesio, O. ; Bais, E. & Van Der Sande, J. J. (1992). Response of brain metastases from breast cancer to systemic chemotherapy. Cancer, 69(4), 972-980. https://doi.org/10.1002/1097-0142(19920215)69:4

Lin, N. ; Bellon, J. R. & Winer, E. P. (2004). CNS Metastases in Breast Cancer. Journal of Clinical Oncology, 22(17), 3608-3617. https://doi.org/10.1200/jco.2004.01.175
DOI: 10.1200/JCO.2004.01.175

Cortes, J.; Rugo, H. S. ; Awada, A. ; Twelves, C. ; Perez, E. A. ; Im, S. ; Gómez-Pardo, P. ; Schwartzberg, L. S. ; Diéras, V. ; Yardley, D. A. ; Potter, D. ; Mailliez, A. ; Moreno-Aspitia, A. ; Ahn, J. S. ; Zhao, C. ; Hoch, U. ; Tagliaferri, M. ; Hannah, A. L. & O’Shaughnessy, J. (2017). Prolonged survival in patients with breast cancer and a history of brain metastases: results of a preplanned subgroup analysis from the randomized phase III BEACON trial. Breast Cancer Research and Treatment, 165(2), 329-341. https://doi.org/10.1007/s10549-017-4304-

Leone, J. P.; Emblem, K. E. ; Weitz, M. ; Gelman, R. S. ; Schneider, B. P. ; Freedman, R. A. ; Younger, J. ; Pinho, M. C. ; Sorensen, A. G. ; Gerstner, E. R. ; Harris, G. ; Krop, I. E. ; Morganstern, D. ; Sohl, J. ; Hu, J. ; Kasparian, E. ; Winer, E. P. & Lin, N. U. (2020). Phase II trial of carboplatin and bevacizumab in patients with breast cancer brain metastases. Breast Cancer Research, 22 (131). https://doi.org/10.1186/s13058-020-01372-w
DOI: 10.1186/s13058-020-01372-w

Bardia, A.; Hurvitz, S. A. ; Tolaney, S. M. ; Loirat, D. ; Punie, K. ; Oliveira, M. ; Brufsky, A. ; Sardesai, S. ; Kalinsky, K. ; Zelnak, A. ; Weaver, R. D. ; Traina, T. A. ;Dalenc, F. ; Aftimos, P. ; Lynce, F. ; Diab, S. ; Cortes, J. ; O’Shaughnessy, J. ; Diéras, V. ; . . . Rugo, H. S. (2021). Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer. The New England Journal of Medicine, 384(16), 1529-1541. https://doi.org/10.1056/nejmoa2028485
DOI: 10.1056/NEJMoa2028485

Diéras, V.; Weaver, R. D. ; Tolaney, S. M. ; Bardia, A. ; Punie, K. ; Brufsky, A. ; Rugo, H. S. ; Kalinsky, K. ; Traina, T. A. ; Klein, L. ; Loirat, D. ; Lynce, F. ; Daniel, B. R. ; Ademuyiwa, F. O. ; Hurvitz, S. A. ; Goldenberg, D. M. ; Hong, Q. ; Olivo, M. ; Itri, L. M. & Carey, L. A. (2021). Abstract PD13-07: Subgroup analysis of patients with brain metastases from the phase 3 ASCENT study of sacituzumab govitecan versus chemotherapy in metastatic triple-negative breast cancer. Cancer Research, 81(4_Supplement), PD13-07. https://doi.org/10.1158/1538-7445.sabcs20-pd13-07
DOI: 10.1158/1538-7445.SABCS20-PD13-07

Duchnowska, R.; Pęksa, R.; Radecka, B. ; Mandat, T. ; Trojanowski, T. ; Jarosz, B. ; Czartoryska-Arłukowicz, B. ; Olszewski, W. ; Och, W. ; Kalinka-Warzocha, E. ; Kozłowski, W. ; Kowalczyk, A. ; Loi, S. ; Biernat, W. & Jassem, J. (2016). Immune response in breast cancer brain metastases and their microenvironment: the role of the PD-1/PD-L axis. Breast Cancer Research, 18 (43). https://doi.org/10.1186/s13058-016-0702-8
DOI: 10.1186/s13058-016-0702-8

Schmid, P.; Chui, S. S. & Emens, L. A. (2018). Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. The New England Journal of Medicine, 379(22), 2108-2121. https://doi.org/10.1056/nejmoa1809615
DOI: 10.1056/NEJMoa1809615

Sharma, P. ; Rodler, E. T. ; Barlow, W. E. ; Gralow, J. R. ; Huggins-Puhalla, S. L. ; Anders, C. K. ; Goldstein, L. J. ; Brown-Glaberman, U. ; Huynh, T. ; Szyarto, C. S. ; Godwin, A. K. ; Pathak, H. B. ; Swisher, E. M. ; Radke, M. R. ; Timms, K. ; Lew, D. L. ; Miao, J. ; Pusztai, L. ; Hayes, D. F. & Hortobagyi, G. N. (2020). Results of a phase II randomized trial of cisplatin +/- veliparib in metastatic triple-negative breast cancer (TNBC) and/or germline BRCA-associated breast cancer (SWOG S1416). Journal of ClinicalOncology. 38:15_suppl, 100. https://doi.org/10.1200/jco.2020.38.15_suppl.1001
DOI: 10.1200/JCO.2020.38.15_suppl.1001

Jusino, S. ; Fadul, C. E. & Dillon, P. M. (2023). Systematic review of the management of brain metastases from hormone receptor positive breast cancer. Journal of Neuro-oncology, 162(1), 45-57. https://doi.org/10.1007/s11060-023-04276-9
DOI: 10.1007/s11060-023-04276-9

Tolaney, S. M.; Sahebjam, S. ; Rhun, E. L. ; Bachelot, T. ; Kabos, P. ; Awada, A. ; Yardley, D. A. ; Chan, A. ; Conte, P. ; Diéras, V. ; Lin, N. ; Bear, M. M. ; Chapman, S. C. ; Yang, Z. ; Chen, Y. & Anders, C. K. (2020). A Phase II Study of Abemaciclib in Patients with Brain Metastases Secondary to Hormone Receptor–Positive Breast Cancer. Clinical Cancer Research, 26(20), 5310-5319. https://doi.org/10.1158/1078-0432.ccr-20-1764
DOI: 10.1158/1078-0432.CCR-20-1764

Figura, N. B. ; Potluri, T. K. ; Mohammadi, H.; Oliver, D. E. ; Arrington, J. A. ; Robinson, T. J. ; Etame, A. B.; Tran, N. D. ; Liu, J. K. ; Soliman, H. ; Forsyth, P. A. ; Sahebjam, S. ; Yu, H. M. ; Han, H. S. & Ahmed, K. A. (2019). CDK 4/6 inhibitors and stereotactic radiation in the management of hormone receptor positive breast cancer brain metastases. Journal of Neuro-Oncology, 144(3), 583-589. https://doi.org/10.1007/s11060-019-03260-6
DOI: 10.1007/s11060-019-03260-6

Franzoi, M. A. & Hortobagyi, G. N. (2019). Leptomeningeal carcinomatosis in patients with breast cancer. Critical Reviews in Oncology Hematology, 135, 85-94. https://doi.org/10.1016/j.critrevonc.2019.01.020
DOI: 10.1016/j.critrevonc.2019.01.020

Perez-Garcia, J. ; Batista, M. L. S. ; Cortez, P. ; Ruiz-Borrego, M. ; Cejalvo, J. M. ; De La Haba-Rodriguez, J. ; Garrigós, L. ; Racca, F. ; Servitja, S. ; Blanch, S. ; Gion, M. ; Nave, M. ; Fernandez-Abad, M. ; Martinez-Bueno, A. ; Llombart-Cussac, A. ; Sampayo-Cordero, M. ; Malfettone, A. ; Cortes, J. & Braga, S. (2022). Trastuzumab deruxtecan in patients with central nervous system involvement from HER2-positive breast cancer: The DEBBRAH trial. Neuro-oncology. Volume 25, Issue 1, January 2023, Pages 157–166 https://doi.org/10.1093/neuonc/noac144
DOI: 10.1093/neuonc/noac144