Cancer Therapy AdvisorGiving BEEP Before WBRT May Improve Control of Brain Metastases in Breast Cancer

Advancing Breast Cancer Treatment: The Impact of BEEP Protocol Prior to Radiotherapy on Brain Metastases Management

Recent research published in JAMA Oncology highlights a significant development in the treatment of brain metastases in breast cancer patients. The study focuses on the effects of administering bevacizumab, etoposide, and cisplatin (BEEP) before whole-brain radiotherapy (WBRT). This approach, explored in the phase 2 A-PLUS trial, marks a potential shift in managing brain-specific progression in breast cancer, offering new insights for physicians in the field.

Key Points:

1. Study Overview: The phase 2 A-PLUS trial (NCT02185352) involved 118 breast cancer patients with brain metastases, assessing the efficacy of BEEP followed by WBRT.
2. Patient Demographics: Participants were WBRT-naïve, predominantly women (median age 56), with 62.5% having hormone receptor-positive breast cancer.
3. Treatment Protocol: Patients received either 3 cycles of BEEP followed by WBRT or WBRT alone, with restrictions on concurrent systemic anticancer therapies.
4. Treatment Outcomes: BEEP before WBRT showed improved brain-specific progression-free survival (PFS) – median PFS of 8.1 months in the BEEP group vs. 6.5 months in WBRT alone.
5. Overall Survival: No significant difference in median overall survival between the BEEP (15.9 months) and WBRT-alone (16.4 months) groups.
6. Response Rates: Post-treatment response rates were 64.9% in the BEEP arm and 76.3% in the WBRT-alone arm, with disease control rates of 91.9% and 89.5%, respectively.
7. Adverse Events: Common AEs in the BEEP group included neutropenia, nausea, anemia, and leukopenia, with some patients experiencing grade 3-4 events.
8. Researcher Conclusion: The study suggests BEEP could be an effective systemic treatment for challenging brain and extracranial metastases in metastatic breast cancer.

According to the American Cancer Society, metastatic breast cancer, particularly brain metastases, remains a significant challenge, with an estimated 15-30% of metastatic breast cancer patients developing brain metastases at some point during their illness.

More on Breast Cancer