Difference between revisions of "CNS carcinoma"

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[[#top|Back to Top]]
 
[[#top|Back to Top]]
 
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{| class="wikitable" style="text-align:center; width:50%;"
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{{#lst:Editorial board transclusions|neuro}}
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! colspan="2" align="center" style="color:white; font-size:125%; background-color:#08519c" |'''Section editor'''
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This page has regimens and guidelines that are not specific to any one type of cancer. For disease-specific regimens and guidelines, please go to the following pages:
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|-
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*[[Breast cancer, CNS metastases]]
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| style="background-color:#F0F0F0" |[[File:SeemaNagpal.jpg|frameless|upright=0.3|center]]
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*[[Non-small cell lung cancer, CNS metastases]]
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|<big>[[User:Seemanagpal|Seema Nagpal, MD]]<br>Stanford University<br>Palo Alto, CA</big>
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{{TOC limit|limit=3}}
 
{{TOC limit|limit=3}}
 
=Guidelines=
 
=Guidelines=
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==[http://www.asco.org/ ASCO]==
+
'''Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.'''
−
*'''2022:''' Schiff et al. [https://doi.org/10.1200/jco.22.00333 Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline]
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==[https://www.asco.org/ ASCO]==
−
*'''2022:''' Ramakrishna et al. [https://doi.org/10.1200/JCO.22.00520 Management of Advanced Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer and Brain Metastases]
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*'''2022:''' Schiff et al. [https://doi.org/10.1200/jco.22.00333 Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline] [https://pubmed.ncbi.nlm.nih.gov/35561283 PubMed]
−
===Older===
 
−
*'''2018:''' Ramakrishna et al. [https://doi.org/10.1200/JCO.2018.79.2713 Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline update] [https://pubmed.ncbi.nlm.nih.gov/29939840 PubMed]
 
−
*'''2014:''' Ramakrishna et al. [https://doi.org/10.1200/JCO.2013.54.0955 Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: American Society of Clinical Oncology clinical practice guideline] [https://pubmed.ncbi.nlm.nih.gov/24799487 PubMed]
 
 
==ASCO/SNO/ASTRO==
 
==ASCO/SNO/ASTRO==
−
*'''2021:''' Vogelbaum et al. [https://doi.org/10.1200/JCO.21.02314 Treatment for Brain Metastases]
+
*'''2021:''' Vogelbaum et al. [https://doi.org/10.1200/JCO.21.02314 Treatment for Brain Metastases] [https://pubmed.ncbi.nlm.nih.gov/34932393 PubMed]
 
==EANO/ESMO==
 
==EANO/ESMO==
−
*'''2021:''' Le Rhun et al. [https://doi.org/10.1016/j.annonc.2021.07.016 EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours]
+
*'''2021:''' Le Rhun et al. [https://doi.org/10.1016/j.annonc.2021.07.016 EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours] [https://pubmed.ncbi.nlm.nih.gov/34364998 PubMed]
−
*'''2017:''' Le Rhun et al. [https://www.esmo.org/Guidelines/Neuro-Oncology/EANO-ESMO-Leptomeningeal-Metastasis-Clinical-Practice-Guidelines EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours]
+
*'''2017:''' Le Rhun et al. [https://www.esmo.org/Guidelines/Neuro-Oncology/EANO-ESMO-Leptomeningeal-Metastasis-Clinical-Practice-Guidelines EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours] [https://pubmed.ncbi.nlm.nih.gov/28881917 PubMed]
−
==[https://www.nccn.org/ NCCN]==
+
==ISRS==
−
*[https://www.nccn.org/professionals/physician_gls/pdf/cns.pdf NCCN Guidelines - Central Nervous System Cancers]
+
*'''2022:''' Grishcuk et al. [https://doi.org/10.1016/j.prro.2022.10.013 ISRS Technical Guidelines for Stereotactic Radiosurgery: Treatment of Small Brain Metastases (≤1 cm in Diameter)] [https://pubmed.ncbi.nlm.nih.gov/36435388/ PubMed]
−
=Unselected all lines of therapy=
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*'''2018:''' Chao et al. [https://doi.org/10.1093/neuros/nyx522 Stereotactic Radiosurgery in the Management of Limited (1-4) Brain Metasteses: Systematic Review and International Stereotactic Radiosurgery Society Practice Guideline] [https://pubmed.ncbi.nlm.nih.gov/29126142/ PubMed]
 +
 
 +
==NCCN==
 +
*''NCCN does not have guidelines at this granular level; please see [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1425 NCCN Guidelines - Central Nervous System Cancers].''
 +
 
 +
=All lines of therapy=
 
==Whole brain irradiation {{#subobject:6115dc|Regimen=1}}==
 
==Whole brain irradiation {{#subobject:6115dc|Regimen=1}}==
 
WBRT: '''<u>W</u>'''hole-'''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy
 
WBRT: '''<u>W</u>'''hole-'''<u>B</u>'''rain '''<u>R</u>'''adiation '''<u>T</u>'''herapy
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{| class="wikitable sortable" style="width: 100%; text-align:center;"  
 
{| class="wikitable sortable" style="width: 100%; text-align:center;"  
 
!style="width: 20%"|Study
 
!style="width: 20%"|Study
−
!style="width: 20%"|Years of enrollment
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!style="width: 20%"|Dates of enrollment
 
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
!style="width: 20%"|Comparator
 
!style="width: 20%"|Comparator
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|2002-2004
 
|2002-2004
 
| style="background-color:#1a9851" |Phase 3 (C)
 
| style="background-color:#1a9851" |Phase 3 (C)
−
|[[#Thalidomide_.26_WBRT_99|Thalidomide & WBRT]]
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|[[#Thalidomide_.26_WBRT_999|Thalidomide & WBRT]]
 
| style="background-color:#ffffbf" |Did not meet primary endpoint of OS
 
| style="background-color:#ffffbf" |Did not meet primary endpoint of OS
 
|-
 
|-
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<div class="toccolours" style="background-color:#b3e2cd">
 
<div class="toccolours" style="background-color:#b3e2cd">
 
====Radiotherapy====
 
====Radiotherapy====
−
*[[External_beam_radiotherapy|Whole-brain irradiation]] 2.5 Gy fractions x 15 (total dose: 37.5 Gy)
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*[[External_beam_radiotherapy|Whole-brain irradiation]] 250 cGy fractions x 15 (total dose: 3750 cGy)
 
'''One course'''
 
'''One course'''
 
</div></div>
 
</div></div>
 
===References===
 
===References===
−
#'''RTOG 0118:''' Knisely JP, Berkey B, Chakravarti A, Yung AW, Curran WJ Jr, Robins HI, Movsas B, Brachman DG, Henderson RH, Mehta MP. A phase III study of conventional radiation therapy plus thalidomide versus conventional radiation therapy for multiple brain metastases (RTOG 0118). Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):79-86. Epub 2007 Dec 31. [https://doi.org/10.1016/j.ijrobp.2007.09.016 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/18164847 PubMed] NCT00033254
+
#'''RTOG 0118:''' Knisely JP, Berkey B, Chakravarti A, Yung AW, Curran WJ Jr, Robins HI, Movsas B, Brachman DG, Henderson RH, Mehta MP. A phase III study of conventional radiation therapy plus thalidomide versus conventional radiation therapy for multiple brain metastases (RTOG 0118). Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):79-86. Epub 2007 Dec 31. [https://doi.org/10.1016/j.ijrobp.2007.09.016 link to original article] '''dosing details in abstract have been reviewed by our editors''' [https://pubmed.ncbi.nlm.nih.gov/18164847/ PubMed] [https://clinicaltrials.gov/study/NCT00033254 NCT00033254]
−
=Breast cancer, HER2-positive, all lines of therapy=
 
−
==Capecitabine & Lapatinib {{#subobject:800fde|Regimen=1}}==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Regimen {{#subobject:653bef|Variant=1}}===
 
−
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 
−
!style="width: 20%"|Study
 
−
!style="width: 20%"|Years of enrollment
 
−
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
−
!style="width: 20%"|Comparator
 
−
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 
−
|-
 
−
|[https://doi.org/10.1200/JCO.2014.57.1794 Pivot et al. 2015 (CEREBEL)]
 
−
|2009-2012
 
−
| style="background-color:#1a9851" |Phase 3 (E-switch-ic)
 
−
|[[#Capecitabine_.26_Trastuzumab_.28XH.29|Capecitabine & Trastuzumab]]
 
−
| style="background-color:#ffffbf" |Did not meet primary endpoint of CNS metastases as first site of relapse
 
−
|-
 
−
|}
 
−
<div class="toccolours" style="background-color:#fdcdac">
 
−
====Biomarker eligibility criteria====
 
−
*Gene: HER2 [[Biomarkers#Genes#Her2|Positive]]
 
−
*Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization
 
−
</div>
 
−
<div class="toccolours" style="background-color:#b3e2cd">
 
−
====Chemotherapy====
 
−
*[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 
−
====Targeted therapy====
 
−
*[[Lapatinib (Tykerb)]] 1250 mg PO once per day
 
−
'''21-day cycles'''
 
−
</div></div>
 
−
===References===
 
−
#'''CEREBEL:''' Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. [https://doi.org/10.1200/JCO.2014.57.1794 link to original article] [https://pubmed.ncbi.nlm.nih.gov/25605838 PubMed] NCT00820222
 
−
==Capecitabine & Trastuzumab (XH) {{#subobject:677608|Regimen=1}}==
 
−
XH: '''<u>X</u>'''eloda (Capecitabine) & '''<u>H</u>'''erceptin
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Regimen {{#subobject:e14cab|Variant=1}}===
 
−
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 
−
!style="width: 20%"|Study
 
−
!style="width: 20%"|Years of enrollment
 
−
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
−
!style="width: 20%"|Comparator
 
−
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 
−
|-
 
−
|[https://doi.org/10.1200/JCO.2014.57.1794 Pivot et al. 2015 (CEREBEL)]
 
−
|2009-2012
 
−
| style="background-color:#1a9851" |Phase 3 (C)
 
−
|[[#Capecitabine_.26_Lapatinib|Capecitabine & Lapatanib]]
 
−
| style="background-color:#ffffbf" |Did not meet primary endpoint of CNS metastases as first site of relapse
 
−
|-
 
−
|}
 
−
<div class="toccolours" style="background-color:#fdcdac">
 
−
====Biomarker eligibility criteria====
 
−
*Gene HER2 [[Biomarkers#Genes.23Her2|Positive]]
 
−
*Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization
 
−
</div>
 
−
<div class="toccolours" style="background-color:#b3e2cd">
 
−
====Chemotherapy====
 
−
*[[Capecitabine (Xeloda)]] 1250 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 
−
====Targeted therapy====
 
−
*[[Trastuzumab (Herceptin)]] as follows:
 
−
**Cycle 1: 8 mg/kg IV once on day 1
 
−
**Cycle 2 onwards: 6 mg/kg IV once on day 1
 
−
'''21-day cycles'''
 
−
</div></div>
 
−
===References===
 
−
#'''CEREBEL:''' Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. [https://doi.org/10.1200/JCO.2014.57.1794 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/25605838 PubMed] NCT00820222
 
−
==Capecitabine & Trastuzumab (XH) & Tucatinib {{#subobject:8d0gg5|Regimen=1}}==
 
−
<div class="toccolours" style="background-color:#eeeeee">
 
−
===Regimen {{#subobject:771gcc|Variant=1}}===
 
−
{| class="wikitable sortable" style="width: 100%; text-align:center;"
 
−
!style="width: 20%"|Study
 
−
!style="width: 20%"|Years of enrollment
 
−
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
 
−
!style="width: 20%"|Comparator
 
−
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
 
−
|-
 
−
|[https://doi.org/10.1056/nejmoa1914609 Murthy et al. 2019 (HER2CLIMB)]
 
−
|2016-2019
 
−
|style="background-color:#1a9851"|Phase 3 (E-RT-esc)
 
−
|[[#Capecitabine_.26_Trastuzumab_.28XH.29_2|XH]]
 
−
| style="background-color:#1a9850" |Superior OS<br>Median OS: 21.9 vs 17.4 mo<br>(HR 0.66, 95% CI 0.50-0.88)
 
−
|-
 
−
|}
 
−
<div class="toccolours" style="background-color:#b3e2cd">
 
−
====Chemotherapy====
 
−
*[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 
−
====Targeted therapy====
 
−
*[[Tucatinib (Tukysa)]] 300 mg PO twice per day
 
−
*[[Trastuzumab (Herceptin)]] as follows:
 
−
**Cycle 1: 8 mg/kg IV once on day 1
 
−
**Cycle 2 onwards: 6 mg/kg IV once on day 1
 
−
'''21-day cycles'''
 
−
</div></div>
 
−
===References===
 
−
# '''HER2CLIMB:''' Murthy RK, Loi S, Okines A, Paplomata E, Hamilton E, Hurvitz SA, Lin NU, Borges V, Abramson V, Anders C, Bedard PL, Oliveira M, Jakobsen E, Bachelot T, Shachar SS, Müller V, Braga S, Duhoux FP, Greil R, Cameron D, Carey LA, Curigliano G, Gelmon K, Hortobagyi G, Krop I, Loibl S, Pegram M, Slamon D, Palanca-Wessels MC, Walker L, Feng W, Winer EP. Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer. N Engl J Med. 2020 Feb 13;382(7):597-609. Epub 2019 Dec 11. Erratum in: N Engl J Med. 2020 Feb 6;382(6):586. [https://doi.org/10.1056/nejmoa1914609 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/31825569 PubMed] NCT02614794
 
−
## '''Subgroup analysis:''' Lin NU, Borges V, Anders C, Murthy RK, Paplomata E, Hamilton E, Hurvitz S, Loi S, Okines A, Abramson V, Bedard PL, Oliveira M, Mueller V, Zelnak A, DiGiovanna MP, Bachelot T, Chien AJ, O'Regan R, Wardley A, Conlin A, Cameron D, Carey L, Curigliano G, Gelmon K, Loibl S, Mayor J, McGoldrick S, An X, Winer EP. Intracranial Efficacy and Survival With Tucatinib Plus Trastuzumab and Capecitabine for Previously Treated HER2-Positive Breast Cancer With Brain Metastases in the HER2CLIMB Trial. J Clin Oncol. 2020 Aug 10;38(23):2610-2619. Epub 2020 May 29. [https://doi.org/10.1200/jco.20.00775 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403000/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/32468955 PubMed]
 
  
 
[[Category:CNS carcinoma regimens]]
 
[[Category:CNS carcinoma regimens]]
 
[[Category:Disease-specific pages]]
 
[[Category:Disease-specific pages]]
 
[[Category:CNS cancers]]
 
[[Category:CNS cancers]]

Latest revision as of 23:40, 15 July 2024

Back to Top

Section editor
SeemaNagpal.jpg
 Seema Nagpal, MD
Stanford University
Palo Alto, CA, USA
LinkedIn

This page has regimens and guidelines that are not specific to any one type of cancer. For disease-specific regimens and guidelines, please go to the following pages:

1 regimens on this page
1 variants on this page


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.

ASCO

ASCO/SNO/ASTRO

EANO/ESMO

ISRS

NCCN

All lines of therapy

Whole brain irradiation

WBRT: Whole-Brain Radiation Therapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Knisely et al. 2007 (RTOG 0118) 2002-2004 Phase 3 (C) Thalidomide & WBRT Did not meet primary endpoint of OS

Radiotherapy

One course

References

  1. RTOG 0118: Knisely JP, Berkey B, Chakravarti A, Yung AW, Curran WJ Jr, Robins HI, Movsas B, Brachman DG, Henderson RH, Mehta MP. A phase III study of conventional radiation therapy plus thalidomide versus conventional radiation therapy for multiple brain metastases (RTOG 0118). Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):79-86. Epub 2007 Dec 31. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00033254
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