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Purpose <p>Improved treatment strategies are needed for HER2 negative breast cancer brain metastases (BCBM). Stereotactic radiosurgery (SRS) is the standard of care for limited brain metastases. Sacituzumab govitecan (SG) may have intracranial efficacy for BCBM; however, safety and efficacy data remain limited when combined with SRS.</p> Methods <p>A multi-institutional retrospective review was performed of patients with HR+/HER2- and triple negative (TNBC) BCBM treated with SG and SRS for active BMs at three institutions. Concurrent SG and SRS was defined as SRS after the date of first SG infusion and before or on the date of last SG infusion. Safety was assessed as well as distant intracranial control (DIC), systemic and central nervous systemic (CNS) progression-free survival (PFS), local control (LC), and overall survival (OS).</p> Results <p>A total of 277 lesions were treated over 36 SRS courses in 26 patients. Median follow up from SG initiation was 23.3 months. One hundred sixty-eight (61%) lesions were treated with single fraction SRS and 109 (39%) lesions were treated with fractionated SRS (fSRS). One hundred thirty-five (47%) lesions received concurrent SRS and SG. No cases of symptomatic radiation necrosis (SRN) were noted. LC rates at 12- and 24-months were 94% and 84%, respectively. Median CNS-PFS was 5.4 months (95% CI 2.8–7.3). Median systemic PFS was 4.4 months (95% CI 2.2–7.3 months). Median overall survival was 8.4 months with a 24-month rate of 16%.</p> Conclusion <p>In our series, concurrent SRS and SG was associated with excellent local control, without an increased risk of SRN. Prospective investigation into potential synergy is warranted.</p>

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Sacituzumab govitecan and stereotactic radiosurgery in the management of HER2 negative breast cancer brain metastases: a multi-institutional report

  • 期刊论文

  • 发表日期：

    2025年9月30日

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  • Vaseem M. Khatri,
  • Mariella A. Mestres-Villanueva,
  • Sierra Daniel,
  • Sreenija Yarlagadda,
  • Ajay Doniparthi,
  • Rituraj Upadhyay,
  • Matthew N. Mills,
  • Daniel E. Oliver,
  • Hsiang-Hsuan Michael Yu,
  • Joshua D. Palmer,
  • Daniel G. Stover,
  • Nicole O. Williams,
  • Reshma L. Mahtani,
  • Manmeet S. Ahluwalia,
  • Aixa E. Soyano,
  • Hatem H. Soliman,
  • Hyo S. Han,
  • Rupesh Kotecha,
  • Sasha J. Beyer,
  • Kamran A. Ahmed

摘要

Purpose

Improved treatment strategies are needed for HER2 negative breast cancer brain metastases (BCBM). Stereotactic radiosurgery (SRS) is the standard of care for limited brain metastases. Sacituzumab govitecan (SG) may have intracranial efficacy for BCBM; however, safety and efficacy data remain limited when combined with SRS.

Methods

A multi-institutional retrospective review was performed of patients with HR+/HER2- and triple negative (TNBC) BCBM treated with SG and SRS for active BMs at three institutions. Concurrent SG and SRS was defined as SRS after the date of first SG infusion and before or on the date of last SG infusion. Safety was assessed as well as distant intracranial control (DIC), systemic and central nervous systemic (CNS) progression-free survival (PFS), local control (LC), and overall survival (OS).

Results

A total of 277 lesions were treated over 36 SRS courses in 26 patients. Median follow up from SG initiation was 23.3 months. One hundred sixty-eight (61%) lesions were treated with single fraction SRS and 109 (39%) lesions were treated with fractionated SRS (fSRS). One hundred thirty-five (47%) lesions received concurrent SRS and SG. No cases of symptomatic radiation necrosis (SRN) were noted. LC rates at 12- and 24-months were 94% and 84%, respectively. Median CNS-PFS was 5.4 months (95% CI 2.8–7.3). Median systemic PFS was 4.4 months (95% CI 2.2–7.3 months). Median overall survival was 8.4 months with a 24-month rate of 16%.

Conclusion

In our series, concurrent SRS and SG was associated with excellent local control, without an increased risk of SRN. Prospective investigation into potential synergy is warranted.