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Clinical Trials for Treatment of Breast Cancer Brain Metastases

This trial will compare whole-brain radiation therapy (sparing the hippocampus when possible) to stereotactic radiosurgery (only targeting the metastases) to see which treatment results in a better quality of life. While stereotactic radiotherapy avoids radiation to the whole brain it will likely lead to more recurrences. Patients must have 5-15 metastases with no prior radiation. Patients who have had surgical removal of 1 or 2 metastases may enroll in the trial. Patients with widespread leptomeningeal disease are not eligible.

The purpose of this study is to see if the number and kind of circulating tumor cells before and 4 or 5 weeks after treatment for brain metastases can help determine the aggressiveness of the disease.  In turn, this could help to determine the aggressiveness of treatment. This study is taking place in Brazil.

The purpose of this study is to see if screening by PET, MRI, or CT (all methods of finding cancer tumors early) may result in better outcomes for patients. Usual care has been to wait until patients develop symptoms of brain and other metastases to screen for them. This screening would take place in patients who are not yet metastatic but have at least a 30% chance of developing metastatic disease. That includes patients with Stage llI breast cancer, chest wall or skin tumors, lymph nodes with extra-nodal extension, internal mammary or supraclavicular nodes, primary tumor more than 2 cm and positive lymph nodes, triple negative breast cancer with 3 or more positive lymph nodes etc.

This single arm study looks at the outcome of stereotactic radiosurgery in patients with 4 or more brain metastases. To qualify, the patient’s tumor must be .5 cm or larger and she can't have had previous whole-brain radiotherapy or stereotactic radiotherapy within 3 months preceding entry into the study. Patients with leptomeningeal disease are excluded. SIMT stands for single-isocenter, multi-target stereotactic radiosurgery which is different than Gamma Knife stereotactic radiosurgery. They appear to have the same efficacy though SIMT is done in a shorter period of time.

The purpose of this study is two-fold. The first is to see if the imaging agent Ferumoxytel can determine tumor drug levels in the brain. The drug that will be used is MM-398, an experimental form of the chemotherapy drug irinotecan. The second purpose is to measure the number of tumor-associated macraphages (immune system cells) in order to predict patient response to treatment. This trial is opened to patients with triple negative breast cancer. Patients may have new or progressing brain metastases but at least one brain metastasis must be at least 1 cm or more in size. 

This Phase ll study is being done to determine if the form of radiation called tomotherapy is effective for patients with brain metastases or leptomeningeal disease that has not responded to or is progressing after regular whole-brain radiation therapy. Tomotherapy combines computed tomography (CT) with guided intensity modulated radiation therapy (IMRT). The radiation is delivered slice by slice and the intensity or strength of the radiation is targeted to the metastases. Patients must have at least 3 or more brain metastases 6 centimeters or leptomeningeal disease. Patients cannot have received previously stereotactic radiotherapy in any other hospital then where the study is taking place (in
China). 

This is a phase ll study to determine the effectiveness of BKM120 (buparlisib) plus capecitabine (Xeloda) in breast cancer patients with brain metastases. Both drugs have been shown to work to work in breast cancer patients and to cross the blood brain barrier. Patients who have Her2-positive disease will also receive trastuzumab (Herceptin). Prior radiation is required to enter this study and patients must have had at least one brain metastasis measuring 5mm in size (in one dimension) prior to the whole-brain radiotherapy. Patients can have have either brain recurrence or not. Those previously receiving stereotactic radiotherapy are excluded from the trial.

This a randomized phase lll trial for patients with metastatic breast cancer and stable brain mets (brain metastases are not progressing). Patients either get the experimental chemotherapy drug etirinotecan or physician's choice out of 7 chemotherapeutic regimes: eribulin, ixabepilone, gemcitabine, paclitaxel, docetaxol and nab paclitaxel given for either primary diagnois or for metastatic disease..Triple negative breast cancer patients must have had at least one prior chemotherapy in the metastatic setting. This drug is a form of irinotecan which remains in cancer tissue longer and is therefore thought to be more effective and less toxic.

The purpose of this phase ll trial is to see if palbociclib (Ibrance), which has already been approved for ER+ metastatic breast cancer, works for ER- and Her2+ brain metastases. There is preclinical evidence that it does. Patients in the trial must have received no more than two different chemotherapies for metastatic disease and must be no less that 2 weeks out from prior treatment. Previous treatment of brain metastases by surgery or stereotactic radiosurgery is permitted. The targeted lesion must be 5 mm or more in size. Those with uncontrolled symptoms of central nervous system disease or leptomeningeal disease are excluded. Herceptin can be continued for those with Her2+ breast cancer.  

The purpose of this phase l trial is to see whether these two drugs work for Her2+ brain metastases delivered intrathecally by lumber puncture directly into the fluid surrounding the brain and spinal cord. Given intravenously (through the veins,) these two drugs have not been able to adequately penetrate the blood brain barrier to reach the tumor. This is also a study to find the best dose so cohorts (groups) of patients will be given 80 mg of Herceptin but different amounts of Perjeta varying from 10 to 80 mg. Patients may have previously treated brain metastases by radiosurgery or resection but it must be at least 1 cm from the targeted metastasis. Patients cannot have leptomeningeal disease. 

This phase lb study is looking at the efficacy of a two-stage immunotherapeutic experimental treatment. Toca 511 is a viral vector which carries a modified yeast gene which makes cytosine deaminese in cancer cells. After the virus infects the cell the pill Toca PC is taken which converts the antifungal 5FC intro the anti cancer drug 5-FU. 5-FU is a well researched chemotherapeutic drug used in breast cancer treatment. The vector delivery system targets cancer cells, hopefully avoiding toxicities in healthy cells. This treatment also blocks the cancer cells from evading the immune system. Treatment of Toca 511 will be delivered by lumbar puncture for three consecutive days. After 14 to 28 days the brain metastases will be surgically removed and evaluated for the presence of vector in the tumor. From 4-6 weeks after recovery from surgery, patients will take toca FC, a pill form of Toca 511 for seven days, to be repeated every six weeks. No investigational drug is allowed in the previous two weeks and no prior antibody therapy is allowed within forty-five days.

The purpose of this phase ll trial is to see if the drug durvalumab, an immunotherapy which has shown efficacy in some solid tumors, will work for brain metastases. Durvalumab keeps cancer cells from blocking the immune system. At least one prior treatment for brain metastases is required and must be completed at least fourteen days before entering the trial. Either brain metastases must have progressed after the prior treatment or new brain metastases must have appeared. Patients with leptomeningeal metastases or patients with some autoimmune diseases can not participate.

 This is a Phase 2 double-blinded randomized trial looking at the effect of tucatinib (ONT-380) on women with HER2+metastatic disease with progressing or stable brain metastases. One arm of the study will get tucatinib with trastuzumab (Herceptin) and capecitibine (Xeloda) and the other will get trastuzumab and capecitabine (which is the standard of care) and a placebo. There were high response rates to the combination Tucatinib and TDM-1 (Kadcyla) in a Phase I trial. To enroll in this study you have to have already had a taxane, trastuzumab, pertuzumab (Perjeta), and TDM-1. Brain metastases must be measurable and those with leptomeningeal disease are excluded. 

This is a Phase II study of eribulin, a chemotherapy drug. The FDA has already approved eribulin for metastatic breast cancer. However, this is the first study looking to see if it works for brain metastases. All participants will receive the drug. Prior treatment with whole-brain radiation, stereotactic radiosurgery or surgery are permitted but not required although patients must have some remaining disease that is measurable.

The purpose of this pilot study (prior to Phase l) is to determine if eribulin emsylate (Halavan) penetrates into brain metastases. Halaven is already FDA approved for treating metastatic breast cancer. In patients where the brain metastasis is going to be surgically removed, or in those willing to undergo a biopsy of their brain metastasis, a microdiaylsis catheter is placed in the brain. Beginning at least 24 hours later eribulin is given for 2-5 minutes. Brain fluid is collected over the next 72 hours and then the catheter is removed. Patients may continue to receive eribulin. Patients may have received prior treatment with radiation or chemotherapy for brain metastases.  

This Phase II study will examine the safety and efficacy of pertuzumab in combination with high-dose Herceptin in people with HER2-positive metastatic breast cancer and central nervous system metastases (excluding leptomeningeal disease). To qualify, patients must have had whole-brain radiation or stereotactic radiosurgery. Both pertuzumab and trastuzumab will be given by IV infusion. This is the first time both drugs will be given in a study of brain metastases, although the combination has been shown to be effective for women with metastatic breast cancer with HER2-positive disease.

This Phase ll study is studying the penetration of the drug afatinib (Gilotrif) into brain metastases for patients having surgical removal of their brain metastases, with or without low-dose targeted radiation. Afatinib is a targeted therapy approved by the FDA for certain kinds of lung cancer that is being studied in a variety of other cancers. In this three-arm randomized study patients will get either no radiation, 2 Gy radiation or 4 Gy radiation prior to surgery. All patients will receive 11 days of afatinib and on day 12 the brain metastasis will be removed. This study is for women presenting with operable brain metastases for the first time including patients with brain metastases when their cancer is first diagnosed.  

 The purpose of this Phase I study is to find out if capecitabine can be given safely with different doses of lapatinib in patients with HER2-positive breast cancerwith brain metastases. Both drugs have been shown to penetrate the blood-brain barrier and to shrink brain metastases and/or leptomeningeal disease. 

 The purpose of this Phase I study is to evaluate the safety of administering a single dose of trastuzumab into the artery for the treatment of brain metastases for HER2 positive breast cancer. It will try to determine the best tolerated single dosage of trastuzumab administered into the artery by gradually increasing the dosage given to participants as the study progresses. Early participants will receive a dosage of 1mg/kg. As more participants enroll in the study, this single dosage will be increased at designated levels up to 8mg/kg if it's determined to be safe to increase. Patents cannot have leptomeningeal disease.

This unrandomized Phase ll trial studies how well pegylated irinotecan (NKTR 102) works in treating breast cancer that has spread to the brain. Pegylation keeps the chemotherapy for a longer period of time in the cancer cells than in normal cells. This experimental agent may stop the growth of tumor cells by blocking enzymes needed for cell growth. Findings from earlier studies suggest that this agent may be effective in breast cancer brain metastases. Patients with either newly diagnosed brain metastases or lesions that have progressed after radiation are eligible. Patients with known leptomeningeal disease must be approved by the sponsor and the principal investigator of the trial.

The purpose of this randomized study is to see if prophylactic (preventative) cranial (whole brain) radiation in patients with metastatic triple negative breast cancer can prevent or lengthen the time before brain metastases might occur. Patients must have had a response to first line chemotherapy in the metastatic setting to be eligible for the trial. Patients will be randomized to radiation or observation. Both safety and efficacy of prophylactic cranial radiation will be measured.    

This Phase ll non-randomized clinical trial is testing the safety and effectiveness of an already FDA approved drug (for another cancer)  to see if it works for breast cancer that has spread to the brain. Phase l studies suggests that cabozantinib may help to shrink or stabilize metastases from breast cancer. In addition, previous studies have shown that cabozantinib may pass through the blood brain barrier which is necessary to treat brain metastases. All patients will receive cabozantinib and if they are HER2-positive they will receive trastuzumab (Herceptin). Patients with newly diagnosed brain metastases or with progressive brain metastases are eligible for the trial. Those with leptomeningeal disease as the only site of central nervous system disease are not eligible.

This pilot trial studies the brain concentration of eribulin mesylate, a chemotherapy that has already been approved for treating metastatic breast cancer. By collecting small samples of brain fluids, this study will examine how well eribulin mesylate concentrates in the brain metastasis. A catheter will be placed in the brain at the beginning of the trial. Brain fluid samples will be collected for 72 hours after receiving eribulin and then the microdailysis is removed. Beginning at least 2 weeks after the tumor has been removed or biopsied patients may continue to receive eribulin. Patients may have received prior treatment of brain metastases with chemotherapy or radiation.

This is a Phase II non-randomized clinical trial to test the safety and efficacy of abemaciclib in hormone receptor positive metastatic breast cancer that is no longer responding to hormonal treatment. Patients can have either Her2+ or Her2- disease. They must have already completed local therapy brain metastases (whole-brain, stereotactic radiation, or surgical removal of brain metastases) and not require any local therapy immediately.  Abemaciclib is a CDK 4/6 inhibitor which blocks cancer cell growth and replication.

In this Phase ll trial, patients will be randomized to receive either the regular treatment of whole brain radiotherapy or the experimental treatment of bevacizumab (Avastin), etoposide and cisplatin prior to whole brain radiotherapy. The thinking behind this experimental strategy is that giving chemotherapy first might shrink the brain metastases, thus making the radiotherapy more effective. Bevacizumab given one day before the etoposide and cisplatin is believed to make the vessels around the tumor less leaky, hopefully ensuring that a larger amount of etoposide and cisplatin is delivered to the metastases. A previous study has shown that  women with recurrent brain metastases after whole brain radiation had an excellent response to the bevacizumab given prior to etoposide and cisplatin. Of these 35 patients 27 or 77% acheived at lease a 50% shrinkage of their brain metastases. The sponsors of this trial predict that this kind of approach will benefit all tumor types, whether ER-positive, ER-negative, or HER2-positive. 

The purpose of this Phase I study is to determine the correct dose of the experimental drug TPI 287 given at the same time as WBRT. The study will also be looking at whether adding TPI 287 to FSRT helps to control brain metastases. TPI is a novel type of Taxol that has been designed to penetrate the blood brain barrier. Women with previous brain metastases are allowed in the trial as long as there is new metastasis that has not yet received radiation. Women with previous WBRT are excluded from the trial

This is a Phase II trial to determine the safety and effectiveness of BKM120 (buparlisib) and capecitabine (xeloda) in  patients with triple-negative breast cancer with measurable brain metastases. Both drugs have shown activity in patients with triple-negative breast cancer and both have been shown to cross the blood brain barrier.  BKM120  stops the activation of PK13 pathway which causes cancer cells to divide.  Patients can not have had more than three different chemotherapies for their metastatic disease and cannot have received capecitabine for metastatic disease. Both drugs are given in pill form and everyone in this trial receives both drugs.

This study is looking at the concept called "rational dose selection" for stereotactic radiosurgery for brain metastases. This concept selects dose based on tumor volume, prior irradiation with whole brain radiotherapy, and the relative radioresistance of the tumor type. In addition, dose may be altered for lesions in the brain stem, adjacent to the optic nerve,optic chiasm or motor cortex. For patients with more than10 brain metastases with other morbidities or difficulty in tolerating a supine position (lying down,doses may be modified by the treating physicians for patient comfort. Patients with leptomeningeal disease are excluded.

The purpose of this study is to collect data to use as a basis for future subsequent studies attempting to increase the efficacy or reduce the toxicity of gamma knife radiosurgery.

This is a Phase ll study of safety and efficacy of DM-CHOC-PEN (a chemotherapeutic agent) for women with breast cancer brain metastases. The phase l study has demonstrated anti cancer activity and there is evidence that it penetrates the blood brain barrier. There will be different doses of drug given to those with or without liver metastases. Radiation or chemotherapy cannot be given concurrently. 

The purpose of this Phase l trial is to study the safety and proper dose for sorafenib, a pill given together with whole brain radiotherapy for women with breast cancer that has metastasized to the brain. Sorafenib controls cell growth by blocking proteins that cause tumor cells to grow. It also decreases the blood supply to the tumor. It has already been approved by the FDA for liver and kidney cancer. Eligible participants may have had a recurrence in the brain after stereotactic radiosurgery.

This study has two components. The first component is a research study comparing which imaging technique tells us more about the the effect of WBRT on brain metastases. A pet scanner with a new radioactive marker 18F FLT PET will be compared to an MRI. The amount of radiation is small and disappears from the body in a few hours. In addition patients will be randomized to get sorafenib or not with WBRT. Sorafenib controls cell growth by blocking proteins that cause tumor cells to grow and it also decreases the blood supply to the tumor. It has been approved by the FDA for liver and kidney cancer.

This study will look at whether lower doses (hypofractionated) image-guided radiation surgery to metastases in different organs will lower the number of circulating tumor cells in the body and extend survival. Patients with metastases in lung, liver, abdomen and extremeties will receive 10 or less doses of hypofractioned doses of radiation and those with brain metastasis will receive a single dose of stereotactic radiation therapy.

The purpose of this Phase II trial is to see whether giving lapatinib (Tykerb) to patients with Her2-positive breast cancer combined with whole-brain radiotherapy is better than giving whole-brain radiotherapy alone. Patients must have progressive disease after surgical removal of the brain metastases or after stereotactic radiosurgery, as well as measurable disease (tumor 10 mm or more). Those with leptomeningeal disease are excluded.Modified whole brain radiotherapy: Hippocampal-avoidance radiotherapy 

This is a randomized trial, taking place in China, that compares two types of whole-brain radiation therapy: one arm avoids radiating the hippocampus and the other does not. The purpose of the study is to see if avoiding the hippocampus results in less neurological decline (decline in mental abilities). The hippocampus is thought to be the part of the brain where memory and cognition is centered

This is a randomized phase lll trial. All patients will receive memantine hydrochoride ( Namenda ) which is a drug shown to improve memory and cognition when given to patients together with whole-brain radiotherapy. Then patients will be randomized to receive regular WBRT or WBRT that does not radiate the hippocampal region of the brain. The hippocampal region of the brain plays an important role in memory and understanding and shielding it from radiation may improve memory and cognition after WBRT. However, it is not known whether not radiating the hippocampal region might increase the risk for recurrences in the brain. Patients must not have had prior WBRT and brain metastases must be 5mm or more from the hippocampus. Patients with leptomeningeal disease do not qualify.

This two-arm randomized trial is being conducted in Germany.  It compares the cognitive function (understanding, learning, and memory) of WBRT versus WBRT that avoids radiation to the hippocampal region of the brain, where memory and cognition are stored. The intent is to study and compare both arms in terms of cognition, recurrence in the brain, and overall survival. It is not known if avoiding the hippocampal region of the brain may increase the chance of recurrence in that area.

This is a two arm study comparing regular whole-brain radiotherapy with whole-brain radiotherapy that avoids the hippocampal area of the brain. Since the hippocampal region is where memory and cognition are stored, protecting this area from radiation may reduce memory loss and  cognitive decline. On the other hand, not giving radiation to the whole brain may increase recurrence of brain metastases.

This phase II single arm study is being conducted in Taiwan. All patients will receive WBRT that avoids the hippocampal region of the brain, where memory and cognition are stored, to see if shielding it from radiation improves cognition and memory. No brain metastases can be larger than 4 cm and patients can't have leptomeningeal disease.

This phase ll randomized trial is taking place in Taiwan. Patients in the trial will receive either conformational WBRT that avoids the hippocampal region of the brain, where memory and cognition are stored, or conformational WBRT that includes the hippocampus. All brain metastases must be at least 5cm from the hippocampus. Patients with leptomeningeal disease are excluded.

This is a phase ll trial looking at a different type of whole brain radiotherapy known as IMRT, which delivers higher doses of radiation to brain metastases while delivering a lower dose of radiation to the rest of the brain. The hope is that the part of the brain without clinical brain metastases will not need as high a dose as the areas that have brain metastases, and that delivering less radiation will reduce toxicity and cognitive side effects.Clinical Trials for Radiation-Caused Necrosis

The purpose of this study is to find out if 18-Fluourocholine can distinguish radiation-caused scarring (called radiation necrosis) occurring in the brain from a recurrence of brain metastases. A pet scan will be done twice the agent (18F-FCHO). This study wil enroll patients who have lesions that are growing afterer stereotactic radiotherapy who will be undgoing brain surgery to determine whether the lesion is radiation necrosis or a recuurrence of metastatic disease in the brain.

The purpose of this clinical trial is to determine whether the use of Trental (pentoxifylline), a drug that improves circulation, and vitamin E can help reduce the incidence of radiation necrosis after radiosurgery. These two drugs are commonly used to treat radiation necrosis when it occurs but this study will try to see if giving these two drugs before radiosurgery can prevent it from every occurring.

This is a single center study of 15 patients with brain lesions being treated at University of North Carolina Hospital. Patients will undergo one FLT-PET-MRI scan before their scheduled surgical biopsy.