From the Guidelines
The first-line treatment for metastatic triple-negative breast cancer with brain metastases should involve a multimodal approach, including systemic therapy with chemotherapy and immunotherapy for PD-L1 positive tumors, and local brain-directed treatments such as stereotactic radiosurgery or whole-brain radiation therapy. For systemic therapy, chemotherapy regimens such as carboplatin with gemcitabine or weekly paclitaxel are commonly used 1. For patients with PD-L1 positive tumors, the addition of immunotherapy with pembrolizumab or atezolizumab to chemotherapy has shown improved outcomes 1. Some key points to consider in the treatment of metastatic triple-negative breast cancer with brain metastases include:
- The importance of addressing symptomatic brain metastases first with local therapy, followed by systemic treatment 1
- The use of single-agent chemotherapy rather than combination chemotherapy as first-line treatment for patients with PD-L1 negative tumors 1
- The consideration of neurosurgical resection for large, symptomatic, or solitary accessible lesions causing significant mass effect
- The challenge of the blood-brain barrier in systemic treatments reaching brain metastases, making local therapies crucial components of treatment Treatment sequencing and choices should be individualized based on the patient's clinical presentation, performance status, and extent of extracranial disease 1.
From the Research
First-Line Treatment Options for Metastatic Triple-Negative Breast Cancer with Brain Metastases
- The treatment of metastatic triple-negative breast cancer (TNBC) with brain metastases is challenging due to the lack of targeted therapies and the difficulty of delivering drugs to the brain past the blood-brain barrier (BBB) 2.
- Systemic chemotherapy is a common treatment option for metastatic TNBC, and some studies have shown that certain chemotherapy regimens can be effective in treating brain metastases 3.
- A study published in 2018 found that the combination of nab-paclitaxel and carboplatin was a effective first-line treatment for patients with metastatic TNBC, resulting in a significantly longer progression-free survival (PFS) compared to other chemotherapy regimens 3.
- Emerging therapeutic drugs, such as poly(ADP-ribose) polymerase inhibitors, immune checkpoint inhibitors, and antibody-drug conjugates, are being investigated for the treatment of metastatic TNBC, including those with brain metastases 4.
- Local central nervous system (CNS) directed therapies, such as radiotherapy, are often used as the first line treatment for brain metastases from breast cancer, followed by systemic therapies to achieve long-term benefit 5.
- However, the role of systemic therapy in the management of brain metastases from TNBC is uncertain, and further research is needed to determine the most effective treatment strategies 2, 5.
Treatment Challenges and Future Directions
- The treatment of brain metastases from TNBC is challenging due to the unique location and biologic properties of the metastases, as well as the lack of targeted therapies 2.
- The development of new therapeutic drugs and treatment strategies is crucial to improve the outcomes of patients with metastatic TNBC and brain metastases 4.
- Further research is needed to investigate the efficacy and safety of different treatment options, including chemotherapy, targeted therapies, and immunotherapies, in patients with metastatic TNBC and brain metastases 2, 3, 5.