Carmustine and methotrexate in combination after whole brain radiation therapy in breast cancer patients presenting with brain metastases: a retrospective study.
BACKGROUND
Since 1999, patients presenting with brain metastases (BM) from breast cancer (BC) are treated in our institution with a carmustine (BCNU)--methotrexate (MTX) combination. We report here our clinical experience regarding this combination.


METHODS
Patients were treated by a combination of BCNU 100 mg/m(2) on day 1 and MTX 600 mg/m(2) on day 1 and 15 of a 28 day cycle. Treatment was continued until progression or unacceptable toxicity.


RESULTS
50 patients were treated between 1999 and 2007. 94% of the patients presented with concomitant extra-cerebral disease. Median number of previous metastatic setting chemotherapy regimens was 2 (0-5). Median number of cycles was 3 (1-20). There were 11 objective responses (23% [95%CI 12-37]) among 48 evaluable patients. Median progression-free survival and overall survival (OS) were 4.2 (95%CI: 2.8-5.3) and 6.9 (4.2-10.7) months respectively, with a one-year OS rate of 32% (20-46). Median Relative Dose Intensity for BCNU and MTX were 0.98 (0.31-1.1) and 0.96 (0.57-1.66) respectively. There were 2 presumed treatment-related deaths. One patient developed febrile neutropenia. Performance status, BS-BM score and presence of liver metastases were associated with OS in univariate analysis.


CONCLUSIONS
This combination appears to be effective and well tolerated in good performance status BC patients presenting with BM.
Department of Medical Oncology, CRLC Val d'Aurelle, Montpellier, France. william.jacot@valdorel.fnclcc.fr
William
W
Jacot
Marie-Cécile
MC
Gerlotto-Borne
Simon
S
Thezenas
Stéphane
S
Pouderoux
Sylvain
S
Poujol
Mahdi
M
About
Gilles
G
Romieu
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D002330:Carmustine; D008727:Methotrexate