Observational studyBreast (Edinburgh, Scotland)2026
Impact of trastuzumab deruxtecan (T-DXd) and brain stereotactic radiosurgery on intracranial control and radionecrosis risk in HER2-positive or -low breast cancer brain metastases.
Observational study in Breast (Edinburgh, Scotland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhile trastuzumab deruxtecan (T-DXd) demonstrates intracranial efficacy, the potential for radionecrosis (RN) when combined with stereotactic radiosurgery (SRS) remains a concern, given the established risk with other antibody-drug conjugates like T-DM1. This study evaluated the safety and efficacy of T-DXd and SRS in patients with HER2-positive or -low breast cancer brain metastases (BCBM).
methodsWe conducted a multi-center retrospective analysis of 113 patients (461 SRS treatments) treated with SRS and anti-HER2 agents. Patients were stratified into T-DXd(+) (n = 29 patients, 61 treatments) and T-DXd(-) (n = 84 patients, 400 treatments) groups. Endpoints included RN, radionecrosis-free survival (RNFS), and intracranial control outcomes (any intracranial progression, local failure, and distant intracranial metastasis).
resultsNo cases of RN were observed in the T-DXd(+) group, compared with 11 cases in the T-DXd(-) group (p = 0.028). On multivariate analysis, T-DXd(+) status remained significantly associated with improved RNFS (HR 0.31, p = 0.009). In the treatment-level analysis, the 1-year cumulative incidence of RN was 0% for T-DXd(+) versus 4.3% for T-DXd(-) (p = 0.009). Additionally, T-DXd(+) was associated with significantly better 1-year outcomes for any intracranial progression (40% vs. 76%, p < 0.001), local failure (6.6% vs. 29%, p = 0.002), and distant intracranial metastasis (40% vs. 66%, p = 0.009). All efficacy endpoints remained significant on multivariate analysis.
conclusionCombining T-DXd with SRS demonstrated a favorable safety profile without increasing the risk of radionecrosis. Furthermore, this combination was associated with superior intracranial control, encompassing both local and distant outcomes, supporting the potential of T-DXd combined with SRS as an effective and well-tolerated approach for HER2-positive or -low BCBM.
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