Drs Carey Anders, Steve Braunstein, Nancy Lin, and Michelle Melisko discuss the management of brain metastasis arising from breast cancer.
demonstrated that there is a benefit, perhaps, to proton-directed craniospinal irradiation for these patients. That's provocative, but really the focus of that trial was on CNS progression and overall survival.
Is there a time when perhaps we could intervene with some comprehensive treatment or combination of radiation and systemic therapy to perhaps avert the presentation of true LMD? I think that is an area of opportunity now in the combination of these proven CNS-directed radiation techniques and CNS-penetrant therapies.
Dr Melisko, with your interest in LMD, what would be your approach for a patient with HER2-positive disease? We'll just pretend that the patient is therapy-naive, or you can think through what you might be considering if they've received certain things. We all recognize that many patients come to us with a very different treatment history, and you have to adapt your thinking based on what the tumor cells have already been exposed to systemically.
We are trying to be able to do that risk stratification, which I think really is going to be, in some ways, the future for patients who have these parenchymal brain metastases that we're picking off with SRS, to see if we can learn something either through biopsy by LITT, as Dr Braunstein brought up, getting a biopsy during a LITT procedure, or looking at CSF as a surrogate for what's going on in the brain.
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