HER2+ MBC: Radiation Necrosis Vs Disease Progression

EP: 1.HER2+ Metastatic Breast Cancer Treatment Advances

EP: 2.Common Symptoms Associated With HER2+ Metastatic Breast Cancer

EP: 3.Chemotherapy for HER2+ MBC

EP: 4.Radiation Therapy for HER2+ De Novo MBC

EP: 5.Subcutaneous Therapies for HER2+ MBC

EP: 6.Talking With Patients About HER2+ MBC Treatment Options

EP: 7.Pursuing a Second Opinion About HER2+ MBC Treatment

EP: 8.HER2+ MBC: Preparing Patients for Chemotherapy

EP: 9.Treatment Strategies for HER2+ Breast Cancer and Brain Metastases

EP: 10.Radiation and Systemic Therapy for HER2+ Breast Cancer and Brain Metastases

EP: 11.Novel Therapies for HER2+ Breast Cancer and Brain Metastases

EP: 12.Shared Decision-Making and Treatment Sequencing in HER2+ MBC

EP: 13.Discussing HER2-Positive Breast Cancer With a Patient Advocate

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EP: 14.HER2+ MBC: Radiation Necrosis Vs Disease Progression

EP: 15.Exciting Developments in the Pipeline in HER2+ MBC

Sara A. Hurvitz, MD: Kamran, I want to ask you 1 question before we round up because we struggle with this in patients who’ve received radiation for brain metastases, and that’s the issue of radiation necrosis. If you could give us a picture of what this is, how we treat it, and approaches being developed to help us distinguish necrosis from progression in the brain.

Kamran Ahmed, MD: Radiation necrosis is 1 of the most worrisome adverse effects that radiation oncologists follow patients for and counsel patients on, in terms of the risks of that happening post-stereotactic treatment. The rates vary in series, but it can occur in up to 15% of patients who receive stereotactic radiation treatment. There’s the potential that if we don’t sequence therapies correctly, there might be a synergistic effect with certain systemic therapies. There are some data showing that immunotherapies might potentially increase the risks of radiation necrosis when combined with stereotactic radiation treatment. This is something that we have to watch for and counsel patients for.

In terms of our diagnosis, the gold standard for a long time has been surgical pathology. For patients who develop radiation necrosis, what’s often needed is surgical resection of that metastasis because it’s difficult to tell whether it’s local progression vs radiation necrosis. There are newer imaging techniques available to us, like MRI perfusion and PET [positron emission tomography]–CT imaging, that can be used to help differentiate. Steroids are commonly given for helping manage the adverse effects of radiation necrosis too, and then sometimes bevacizumab as well. There are improvements that we’re making in terms of the diagnosis and potential management of radiation necrosis.

Sara A. Hurvitz, MD: Thank you. It’s a really important thing for clinicians to be aware of. Sometimes the assumption is its progression. It takes a multidisciplinary team to sort out if it’s progression or necrosis. Thank you for that update.

Transcript edited for clarity.