Potential New Therapeutic Target For Brain Metastases From Breast Cancer
Metastatic breast cancer is breast cancer that has spread to another part of the body, most commonly the liver, brain, bones, or lungs. There are many treatment options that are available for metastatic breast cancer including surgery, chemotherapy, radiation therapy, and now there may be a new treatment that will offer hope. Researchers led by CU Cancer Center member Diana Cittelly, PhD, report a potential new treatment option for breast cancer that spreads to the brain.
Their findings are published in the journal Clinical Cancer Research, in a paper titled, IL13R2 promotes proliferation and outgrowth of breast cancer brain metastases.
The researchers investigated the role of interleukin 13 receptor alpha 2 , a protein that is found in increased rates in cancer cells that metastasize to other locations in the body.
We found that patients expressing high levels of IL13Ra2 in their brain metastases have worse survival than those expressing low levels of IL13Ra2, but we could not see this correlation when examining the primary tumors. That was important because it suggested that there is an adaptation of the cancer cells when they spread to the brain, and we could eventually target it, Cittelly said. We were able to identify a role for this receptor as a tool in promoting the proliferation and outgrowth of metastasis in the brain.
Radiation Therapy For Metastatic Brain Tumors
Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.
These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:
- External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
- Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
- Stereotactic radiosurgery directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
- Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.
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Natural Course And Prognostic Factors
CNS metastases tend to occur late in the course of MBC and are associated with 1- and 2-year survival rates of only 20% and < 2%, respectively . Most breast cancer patients with CNS metastases die of systemic disease progression . Hall et al. reported that the survival rate of patients with CNS metastases from breast cancer was 8.0% at 2 years, 6.9% at 3 years, and 1.3% at 5 years. The median survival time for patients with breast cancer with untreated brain metastasis is 4 weeks this can be increased to 46 months with whole-brain radiotherapy and stereotactic radiosurgery or up to 16 months if solitary metastases can be removed surgically .
Performance status of patients is a prognostic factor in each diagnosis of brain metastases with breast cancer. Clinicians should take the time accurately to assess and document their patients’ performance status . The Karnofsky Performance Status has been found to be a significant prognostic factor for survival in patients with brain metastases from breast cancer , and most long-term survivors have KPS scores of 70100 .
Other prognostic factors for brain metastasis include size of the primary tumor , interval from the first cancer diagnosis to brain metastases , number of brain metastases , presence of a solitary metastasis , age , ER status , administration of systemic chemotherapy , whole-brain radiation dose of 30 Gy or greater and the presence and degree of extracranial metastases .
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Most Common Places It Spreads
It’s still breast cancer, even if it’s in another organ. For example, if breast cancer spreads to your lungs, that doesn’t mean you have lung cancer. Although it can spread to any part of your body, there are certain places it’s most likely to go to, including the lymph nodes, bones, liver, lungs, and brain.
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Immunotherapy For Metastatic Brain Tumors
Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune systems natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as checkpoint inhibitors. Normally, tumor cells can evade attack by activating certain proteins that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.
Immunotherapy drugs to treat metastatic brain tumors include:
- Atezolizumab
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Who Is Most At Risk For Brain Mets
People with breast cancer, colon cancer, melanoma , lung cancer, and kidney cancer are most at risk for developing brain mets.
Breast cancer is the most common cause of brain mets in women. People with aggressive subtypes of breast cancer, including HER-2 positive and triple-negative breast cancers, have a greater chance of getting brain mets.
An Algorithm For Local And Systemic Treatment For Brain Metastases In Breast Cancer Patients
We have developed an algorithm for the treatment of brain metastasis in women with breast cancer . If a patient has any brain tumor with diameters of 3 cm or more, clinicians should recommend surgery. Surgery is required for large brain metastases to maintain good quality of life, because local control is poor with radiotherapy . If a patient has 14 small brain metastases , clinicians should recommend surgery or SRS first to reduce the risk of experiencing major neurocognitive decline. WBRT after surgery or SRS is not recommended for patients who have a limited number of brain metastases, because WBRT following SRS or surgical resection does not prolong overall survival in these patients. If a patient has five or more brain metastases, clinicians should recommend WBRT . However, if a patient has five or more brain metastases with a total cumulative tumor volume 15ml, clinicians may recommend SRS . After local therapy for brain metastasis to control symptoms, despite the lack of adequate prospective data supporting changes in treatment after developing brain metastasis, we believe that tailoring treatment with regard to the strategy for local brain therapy and systemic therapy is a rational approach. If the patient’s response is classified as progressive systemic disease, systemic treatment should be changed. If, however, the patient’s response is classified as stable systemic disease without brain metastases, systemic treatment should be continued.
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Mechanisms Of Breast Cancer Metastasis
No one really knows what factors will make a certain patient more or less susceptible to breast cancer metastasis.
There is growing awareness that part of that susceptibility is due to host factors. The host factors are the characteristics of the non-malignant cells and the general biological environment surrounding the malignant breast tumor.
Sometimes the host factors are referred to as the pre-metastatic niche and it is thought that bone-marrow-derived progenitor cells may directly influence the dissemination of malignant cells to distant areas.
Non-neoplastichost cells within the tumor may also play a key role in the regulation of breast cancer metastasis.
What Are Metastatic Brain Tumor Symptoms
Metastatic brain tumor symptoms differ based on your tumors location. Those symptoms can mimic stroke symptoms. But while stroke symptoms come on suddenly, metastatic brain tumor symptoms appear and get worse over time, from days to weeks. These symptoms include:
- Headaches caused by a tumor putting pressure on your brain. Your headaches may also stem from fluid leaking from your tumors blood vessels.
- Seizures that happen when your tumor interferes with your brains normal electrical activity.
- Cognitive problems, meaning you have trouble processing information or how you think. You may have trouble remembering things that just happened.
- Changes in how you behave or in your mood.
- Weakness on one side of your body, or not being able to use your arm or leg on one side of your body.
- Problems hearing, swallowing or seeing.
- Nausea and vomiting.
- Difficulty speaking or understanding speech.
Do I have metastatic brain cancer if I have any of these symptoms?
Many of these symptoms such as headaches, nausea and vomiting, or mood changes are also caused by other less serious conditions. Generally speaking, any change in your body that lasts more than a few weeks is something you should discuss with your healthcare provider.
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How Common Are Brain Mets
Approximately 200,000 Americans with all types of cancer develop brain mets every year.
Brain mets affect approximately 1 in 10 women with metastatic breast cancer. For about 17% of these women, cancer spreads only to the brain. More commonly, metastatic breast cancer goes to bones or other organs first, and then may eventually affect the brain.
What Happens When Breast Cancer Spreads To The Brain
Secondary breast cancer in the brain happens when breast cancer cells spread to the brain. It can also be known as brain metastases. You may also hear this type of spread described as metastatic breast cancer, metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer.
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Where In The Body Does Breast Cancer Spread
In theory, breast cancer can spread to any part of the body, but it most commonly spreads to the lymph nodes, lungs, liver, bones and sometimes the brain. Keep in mind though, that even if your breast cancer spreads to other areas of your body, its still considered breast cancer. For example, if breast cancer spreads to your lungs, it does not mean that you now have lung cancer too.
If your breast cancer has moved to other parts of your body, you might experience symptoms relating to the area it has spread to, but not always.
Here Dr. Roesch explains how metastatic breast cancer can affect different parts of the body:
What You Need To Know
- Metastatic brain cancer is caused by cancer cells spreading to the brain from a different part of the body.
- The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin , colon, kidney and thyroid gland.
- Metastatic brain tumors are five times more common than primary brain tumors .
- Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.
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What Are The Signs Of Breast Cancer
While breast is more common in older women, it does affect the younger generation and men too with around 20 per cent of cases occurring in females under 50 and 350 male cases diagnosed in the UK annually.
While 90 per cent of such lumps are not cancerous, it is vital to get them checked by your GP at the earliest opportunity detecting the disease early can mean treatment is more effective.
It is therefore vitally important to be breast aware know what feels normal for you, and therefore what changes to look out for.
The most common signs to know include:
- A lump or swelling in the breast, upper chest or armpit. You might feel the lump, but not see it.
- Changes in the size or shape of the breast
- A change in skin texture i.e. puckering or dimpling of the skin
- A change in the colour of the breast the breast may look red or inflamed
- Rash, crusting or changes to the nipple
- Any unusual discharge from either nipple
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Systematic Screening For The Detection Of Bm
Due to the lack of data demonstrating a clinical benefit, brain screening for patients with MBC is not currently recommended in the US NCCN and ESMO guidelines. Nevertheless, patients at high risk of developing BM could potentially benefit from screening strategies, as an earlier diagnosis could lead to a reduction in WBRT use and enable localised, less toxic and more effective BM treatment in a higher proportion of cases.,, Four studies are exploring the value of systematic radiological screening.
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Hello I Usually Post On The
Hello I usually post on the breast cancer page but was reading around in here since mine has now developed into the liquid in my brain and spine. I had a ommaya resovor put in and have received 2 treatments in it so far. No one has given me an expiration date! and I dont want one. The spinal tap or lumbar puncture is very painful BUT they also pull fluid out of the ommaya port in my head which is not painful at all neither are the treatments. I had a seizure on May 29th and am still recovering from that so I am a little weak still and am walking with a walker and Im only 43 hope to be strong enough to get off the walker SOON!!! Have hope and help her fight!!!
How Are Metastatic Brain Tumors Diagnosed
Metastatic brain and spine tumors are not usually diagnosed until symptoms appear. Here are some ways doctors may diagnose a metastatic brain tumor:
- Physical exam: After gathering information about your symptoms and personal and family health history, the doctor proceeds with a physical exam and vision and reflex tests.
- Magnetic resonance imaging
- Diffusion tensor imaging is a type of MRI that visualizes how water molecules pass through parts of the brain. It reveals microscopic differences of tissue structure, including very early infiltration of cancer cells.
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Researchers Discover New Way To Target Secondary Breast Cancer That Has Spread To The Brain
- Date:
- RCSI
- Summary:
- A study has revealed a potential new way to treat secondary breast cancer that has spread to the brain, using existing drugs.
A study led by researchers at RCSI University of Medicine and Health Sciences and the Beaumont RCSI Cancer Centre has revealed a potential new way to treat secondary breast cancer that has spread to the brain, using existing drugs.
The study, published in Nature Communications, was funded by Breast Cancer Ireland with support from Breast Cancer Now and Science Foundation Ireland.
Most breast cancer related deaths are a result of treatment relapse leading to spread of tumours to many organs around the body. When secondary breast cancer, also known as metastatic breast cancer, spreads to the brain it can be particularly aggressive, sometimes giving patients just months to live.
The RCSI study focused on genetically tracking the tumour evolution from diagnosis of primary breast to the metastatic spread in the brain in cancer patients. The researchers found that almost half of the tumours had changes in the way they repair their DNA, making these tumours vulnerable to an existing type of drug known as a PARP inhibitor. PARP inhibitor drugs work by preventing cancer cells to repair their DNA, which results in the cancer cells dying.
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Brain Metastasis Symptoms And Diagnosis
About 10% to 15% of people with stage IV breast cancer have brain metastases. For most people with metastatic breast cancer that has spread to the brain, the breast cancer has already traveled to another part of the body, such as the bones, lungs, or liver. But for about 17% of people with brain metastasis, the breast cancer has only spread to the brain.
The risk of brain metastasis is usually highest for people with more aggressive subtypes of breast cancer, such as HER2-positive or triple-negative breast cancer.
Symptoms of breast cancer that has spread to the brain can include:
-
seizures
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stroke , which means the blood supply to the brain is cut off symptoms can include sudden weakness or numbness on one side of the body, headache, trouble speaking, vision changes, dizziness, or loss of balance
Using an MRI scan, often with contrast solution, a doctor can confirm that breast cancer has spread to the brain. Contrast solution is dye that is injected into your arm through an intravenous line. The dye travels to the brain and helps cancerous tissue show up more clearly on the images.
In rare cases, doctors order a biopsy to confirm brain metastasis. To get a tissue sample, a surgeon drills a small hole through the skull. Using MRI or CT scans, a surgeon can guide a narrow, hollow needle into the brain lesion and remove a sample. The surgeon then sends the sample to a pathologist for examination.
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What Is A Metastatic Brain Tumor
A metastatic brain tumor is one of several types of metastatic cancer. Brain metastases, or metastatic brain tumors, happen when cancer in one part of your body spreads to your brain. Most metastatic brain tumors spread from primary cancers in your lungs, your breasts or your skin, specifically melanoma.
Researchers are finding more ways to predict who might develop brain metastases so healthcare providers can monitor for signs of metastatic brain tumors. Healthcare providers treat metastatic brain tumors by managing your symptoms through surgery and other treatments and helping you maintain your quality of life.