Neoplasms

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Carcinoma

Breast Neoplasms

Breast Diseases

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Trastuzumab

This study will examine a non-invasive method to assess vasculature, that is, the development of a blood supply necessary to the growth of tumors. The hope is to identify the way that genes are expressed within the tumor itself, from areas shown as low flow versus those shown as high flow on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).

Most patients with solid epithelial cancers, those that develop on free surfaces or linings inside the body, die because of the distant spread of tumors-metastasis. After that spread, a cure is more difficult than if the tumors were detected early or locally. Tumors develop a new supply of blood. Traditional anticancer therapies have had the goal of causing a decline in the tumor. Yet by focusing on the tumor's blood supply, microscopic differences between tumors and clonal differences within tumors may be avoided. Doing so may overcome tumor resistance to treatment and may result in treatments that can be more universally applied across tumor types.

Female patients 18 years of age enrolled in the protocol Analysis of Brain Metastasis in Patients with Breast Cancer, with and without Over-Expression of HER-2, who will undergo an MRI scan immediately before surgery will be invited to participate in this study. Patients seen in the oncology outpatient clinic of the NIH Clinical Center or by referral from outside physicians may be eligible for this study.

Participants will undergo DCE-MRI immediately before the craniotomy-the surgery scheduled-in conjunction with other clinically indicated MRI. The preoperative MRI will take about 30 minutes, and the DCE-MRI will take no more than 15 minutes. During the MRI, patients will lie still on a table that can slide in and out of a metal cylinder surrounded by a strong magnetic field. They may be asked to lie still for up to 5 minutes at a time. As the scanner takes pictures, there will be loud knocking noises, and the patients will wear earplugs to muffle the sound. Patients will be able to communicate with the MRI staff at all times during the scan and may ask to be moved out of the machine at any time. During part of the MRI, patients will receive a contrast agent, one that is gadolinium-based, into a vein. This agent changes the relative brightness or contrast on the MRI image under some conditions. Before that agent is used, patients will be asked about any previous allergic reactions to gadolinium-based contrast agents.

Introduction: Metastasis of epithelial tumors, such as breast cancer, to the brain is a common problem, with significant consequences with respect to neurological dysfunction and shortening of survival. One necessary step for tumor growth anywhere is the development of a blood supply.

Objectives: We seek to compare a new, non-invasive method of assessing neo-vascularization, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with a gold-standard-microvessel counts-and to see if we can identify gene expression patterns within the tumor itself, from areas shown as low flow versus those that are high-flow on DCE-MRI if there are features within the tumor itself that influence the degree of neovascularization. This prospective study will only be utilized in conjunction the protocol entitled "Analysis of Brain Metastasis in Patients with Breast Cancer, with and without over-expression of HER-2" that is evaluating breast tumors metastatic to the brain.

Study Population: A series of women with breast cancer metastatic to the brain who do (n=39) or do not (n=39) over-express the growth factor receptor, HER-2, entered into a prospective trial in which pre-operative MRI imaging is performed as a matter of standard medical practice. At the time of this pre-operative MR, we propose to add one additional, 10-minute MR series, a dynamic, contrast-enhance image to assess the extent of blood flow through various aspects of the tumor.

Anticipated Risks and Benefits: There are no obvious risks or benefits to patients who participate in this protocol. It is felt that this study involves no more than minimal risk.

Estimation of Outcome/Potential Meaning: We believe that this protocol will help us identify tumors with higher or lower degrees of neovascularization as well as identify tumor-intrinsic factors via microarrays performed on microdissected tissues. This is becoming an important issues as cytostatic treatments, such as anti-angiogenic agents, enter the clinical area, and are used singly or in combination with cytotoxic therapies.

Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging to Assess Tumor-Associated Vasculature in Patients With Metastatic Breast Cancer

National Institute of Neurological Disorders and Stroke (NINDS)

Nervous System Diseases

Symptoms and General Pathology

Brain Neoplasms

Neoplasm Metastasis

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

This study will examine two subsets of patients with breast cancer metastasis, that is, spreading, to the brain. It will identify genes and proteins that promote metastasis, particularly in women who are found to over-express (have more than other people do) the human epidermal growth factor receptor, ErbB2, also known as HER-2. The molecular and genetic events that permit tumor metastasis are not well understood. There is intense investigation going on into the process in which tumor cells escape the primary local tumor, spread to distant places in the body, and find and create conditions that promote growth in those tissues. Metastasis of tumors such as breast cancer to the brain is a common problem. Tumor cells will be analyzed with the use of microarrays. A microarray is a tool for analyzing gene expression, consisting of a small membrane or glass slide containing samples of many genes arranged in a regular pattern. The goal is to identify a potential molecular signature. It is hoped that there will be discovery of why some patients are more likely than others to develop a brain metastasis, which can have a major negative effect on the quality of life and survival.

Female patients 18 years of age with known or evidence by radiology of a breast tumor metastatic to the brain or those who have had a removal of a brain tumor for diagnosis or treatment may be eligible for this study.

Participants will undergo the following procedures and tests:

* Craniotomy, that is, surgical opening of the skull, and removal of the brain tumor.
* Blood specimens taken from a central vein or artery before the operation, throughout as needed, and for several days afterward, to measure blood chemistries, blood count, and so forth.
* Physical examination and imaging of the central nervous system before and after surgery.
* Urine or serum, or both, pregnancy test of women of childbearing potential.

Patients will also undergo blood tests at 3-month intervals after surgery for up to 5 years. The purpose is to determine if there are tumor cells in the blood, which may explain how they reached the brain.

Introduction: The molecular and genetic events that permit tumor metastasis are not well understood. The process whereby tumor cells escape the primary, local tumor, spread to distant sites in the body and find and create conditions conducive to growth in these disparate tissues remains an area of intense investigation. Metastasis of epithelial tumors, such as breast cancer, to the brain is a common problem, with significant consequences with respect to neurological dysfunction and shortening of survival.

Objective: To study two subset of patients with breast cancer metastatic to the brain, to identify genes and proteins that facilitate metastasis, particularly in women who over-express the growth factor receptor HER2, in which an increased risk of brain metastasis has recently been identified.

Study Population: 78 patients with breast cancer metastatic to the brain (39 women whose tumors are HER2-(-) and 39 women whose tumors are HER2-(+)) to compare with published microarray studies of non-metastatic breast cancer patients with these tumor types as well as with one another to help explain the differential trend toward metastasis in patients treated with Herceptin, a new therapy directed at HER-2 over-expressing tumors.

Anticipated Risks and Benefits: Less than minimal risk to the patients to sample tissue already removed from the brain as part of medically-necessary surgery and to sample blood. No direct benefit to the patient is expected.

Outcome Estimate and Potential Meaning for the Field: That this very detailed investigation of the genes and proteins expressed differentially between the non-metastatic and metastatic breast cancers, as well as between HER2-(-) and HER2-(+) subtypes will identify new or previously-unsuspected targets for new therapies to either prevent the development of brain metastasis or to treat these brain metastases more effectively.

Analysis of Brain Metastasis in Patients With Breast Cancer, With and Without Over-Expression of HER-2

Study title	NCT ID	Conditions	Eligibility	Organization
Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging to Assess Tumor-Associated Vasculature in Patients With Metastatic Breast Cancer	NCT00071357	Breast Neoplasm...	-	National Institutes of Health Clinical Center (CC)
Analysis of Brain Metastasis in Patients With Breast Cancer, With and Without Over-Expression of HER-2	NCT00071383	Breast Neoplasm...	-	National Institutes of Health Clinical Center (CC)
Analysis of Brain Metastasis in Patients With Breast Cancer, With and Without Over-Expression of HER-2	NCT00071383	Breast Neoplasm...	-	National Institutes of Health Clinical Center (CC)

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