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dc.contributor.authorOkines, Aen_US
dc.contributor.authorIrfan, Ten_US
dc.contributor.authorKhabra, Ken_US
dc.contributor.authorSmith, Ien_US
dc.contributor.authorO'Brien, Men_US
dc.contributor.authorParton, Men_US
dc.contributor.authorNoble, Jen_US
dc.contributor.authorStanway, Sen_US
dc.contributor.authorSomaiah, Nen_US
dc.contributor.authorRing, Aen_US
dc.contributor.authorJohnston, Sen_US
dc.contributor.authorTurner, Nen_US
dc.coverage.spatialUnited Statesen_US
dc.date.accessioned2017-09-18T09:08:44Z
dc.date.issued2018-05en_US
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/28833867en_US
dc.identifier.citationBreast J, 2018, 24 (3), pp. 253 - 259en_US
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/827
dc.identifier.eissn1524-4741en_US
dc.identifier.doi10.1111/tbj.12906en_US
dc.description.abstractAdo-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate that does not cross an intact blood-brain barrier. In the EMILIA trial of T-DM1 vs capecitabine/lapatinib for HER2 positive advanced breast cancer, all patients had baseline brain imaging, and 9/450 (2%) of patients with negative baseline imaging developed new brain disease during T-DM1. We assessed the frequency of brain progression in clinical practice, without routine baseline imaging. We undertook a retrospective study of all patients treated with T-DM1 at the Royal Marsden Hospital from 2011 to 2016. Data collected included baseline characteristics, previous treatment for advanced breast cancer, sites of metastatic disease, duration of T-DM1, sites of progression, and treatment of CNS progression. Fifty-five patients were identified who had received a median of two prior lines of treatment (range 0-5). All were HER2 positive; 45 patients had IHC 3+ tumors and 10 were ISH positive. Patients received a median of 12 cycles of T-DM1 (range 1-34), and six remain on treatment at the time of analysis. Before commencing T-DM1, 16/55 (29%) had known brain metastases (treated with whole brain [9] stereotactic radiotherapy [6] or both [1]). Brain was the first site of progression in 56% (9/16) patients, with a median time to brain progression of 9.9 months (95% CI 3.9-12.2). In patients without known baseline brain metastases, 17.9% (7/39) developed new symptomatic brain disease during T-DM1, after a median of 7.5 months (95%CI 3.8-9.6). Brain progression was isolated, with control of extra-cranial disease in 4/7 patients. Only one patient was suitable for stereotactic radiotherapy. Median time to extra-cranial progression in all patients was 11.5 months (95% CI 9.1-17.7), and median OS in all patients was 17.8 months (95% CI 14.2-22). In patients not screened for brain metastases at baseline, the brain was the first site of progression in a significant proportion. Baseline brain imaging may have a role in standard practice for patients commencing T-DM1 therapy.en_US
dc.format.extent253 - 259en_US
dc.languageengen_US
dc.language.isoengen_US
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
dc.subjectHER2 positiveen_US
dc.subjectT-DM1en_US
dc.subjectbrain metastasesen_US
dc.subjectAdulten_US
dc.subjectAgeden_US
dc.subjectAged, 80 and overen_US
dc.subjectAntineoplastic Agents, Immunologicalen_US
dc.subjectBrain Neoplasmsen_US
dc.subjectBreast Neoplasmsen_US
dc.subjectCerebral Hemorrhageen_US
dc.subjectFemaleen_US
dc.subjectHumansen_US
dc.subjectMaytansineen_US
dc.subjectMiddle Ageden_US
dc.subjectReceptor, ErbB-2en_US
dc.subjectRetrospective Studiesen_US
dc.subjectTrastuzumaben_US
dc.subjectTreatment Outcomeen_US
dc.titleDevelopment and responses of brain metastases during treatment with trastuzumab emtansine (T-DM1) for HER2 positive advanced breast cancer: A single institution experience.en_US
dc.typeJournal Article
dcterms.dateAccepted2017-01-23en_US
rioxxterms.funderThe Institute of Cancer Researchen_US
rioxxterms.identifier.projectUnspecifieden_US
rioxxterms.versionofrecord10.1111/tbj.12906en_US
rioxxterms.licenseref.startdate2018-05en_US
rioxxterms.typeJournal Article/Reviewen_US
dc.relation.isPartOfBreast Jen_US
pubs.issue3en_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Breast Cancer Research/Molecular Oncology
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Cancer Biology
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Cancer Biology/Targeted Therapy
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Treatment of thoracic tumours/Treatment of thoracic tumours (hon.)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Targeted Therapy
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublisheden_US
pubs.volume24en_US
pubs.embargo.termsNot knownen_US
icr.researchteamMolecular Oncologyen_US
icr.researchteamMedicine (RMH Smith Cunningham)en_US
icr.researchteamTreatment of thoracic tumoursen_US
icr.researchteamTargeted Therapyen_US
dc.contributor.icrauthorTurner, Nicholasen_US
dc.contributor.icrauthorSmith, Ianen_US
dc.contributor.icrauthorO'Brien, Maryen_US
dc.contributor.icrauthorSomaiah, Navitaen_US
dc.contributor.icrauthorJohnston, Stephenen_US
dc.contributor.icrauthorMarsden,en_US
rioxxterms.funder.project354849bd-c553-4e22-868c-8c503e124155en_US


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