Current Treatment Options for Breast Cancer Brain Metastases.

OPINION STATEMENT: In the past, the standard of care for treatment of BM was whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. There has been a greater role for medical therapies in the last two decades due to the discovery of driver mutations and corresponding targeted therapies. These innovations have dramatically altered the approach to treating these patients. Some of the important mutations include epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations in small cell lung cancer, human epidermal growth factor receptor (HER2) mutation in breast cancer, and BRAF mutation in melanoma. Disease-specific graded prognostic assessments have identified prognostic factors for each of the major tumor types associated with BM. These reflect the increased treatment sensitivity of these tumors to specific agents. Furthermore, there is a difference in the genetic makeup of BM compared to their primary tumor. Genomic studies of BM patients comparing somatic point mutations and copy number variations with their primary tumor have demonstrated that while both the primary tumor and BM share a number of common mutations, BM can often develop distinct mutations. Therefore, there is a need to individualize systemic therapies in BM. Several organizations including the Food and Drug Administration and the American Society of Clinical Oncology now emphasize the inclusion of BM patients in various phases of clinical drug development.

Urothelial carcinoma with mandibular metastasis and synchronous prostate cancer.

Only 4% of newly diagnosed bladder cancer (BC) patients present with metastatic disease. The most common reported sites of metastases are lymph nodes, bones, lung, liver and peritoneum. Mandibular metastasis is very rare. We report a case of muscle-invasive urothelial cancer metastasised to the mandible and with an incidental finding of high-risk prostate cancer (PC). Incidental finding of PC in BC patients may be suggestive of a common aetiology. Treatment for BC and PC can be delivered in parallel, including platinum-based chemotherapy, cystectomy and androgen depletion therapy. Prognosis of metastatic BC is poor, and high-risk PC may affect progression-free survival of BC. Our case highlights importance of considering BC metastasis to the jaw as well as synchronous PC in the management of patients presenting with BC.