Breast cancer subtypes and outcomes of central nervous system metastases

Abstract

Central nervous system (CNS) metastases are detected in up to one third of patients with advanced breast cancer, but their incidence and outcomes by breast cancer subtypes are not precisely documented. Herein, we retrospectively analyzed clinicopathologic data of 259 breast cancer patients with CNS metastases to evaluate the association between breast cancer subtypes and CNS metastasis. The patient groups were classified according to their hormone receptor status and HER-2 expression. Median follow-up time among the patients was 42 months and median survival after CNS metastasis detection was 7.8 months. In HER-2 overexpressing group, median time period between the diagnosis of breast cancer and the detection of CNS metastasis (15.9 months) was significantly shorter compared to the other groups (p = 0.01). The triple negative group had the shortest median survival time after CNS metastasis (6.6 months), although statistically not significant (p = 0.3). In multivariate Cox regression analyses, having solitary CNS metastasis (HR 0.4, 95% CI; 0.2-0.7, p = 0.004), and receiving chemotherapy after CNS metastasis (HR 0.4, 95% CI; 0.287-0.772, p = 0.003) were independent prognostic factors for increasing survival after CNS metastasis. In conclusion, new and effective treatment strategies are required for breast carcinoma patients with brain metastasis considering the positive effect of the treatment on survival.

Biological Subtypes and Survival Outcomes in Breast Cancer Patients with Brain Metastases (Study of the Anatolian Society of Medical Oncology)

“…In the present study, the median OS after brain metastasis was approximately 10 months and better than according to other published data [4,12,13,14]. We think that this may be due to several reasons.…”

“…Survival was reported to be about 1.5 years in HER2-positive patients with brain metastasis treated with targeted treatment [16,17]. While targeted treatment is employed in 70% of HER2-positive patients (HER2-overexpressing and luminal B) in our study, it was employed in 36% [12] and 47% in studies which reported lower survival [14]. In line with this and previous studies, the triple negative subgroup had lower survival rates than the other subgroups in our study [4,12,13,14].…”

“…Brain metastasis of breast cancer is becoming a more common finding as a result of advancements in the therapy of metastatic disease and imaging techniques [5]. Although systemic treatments are not believed to enter into the brain because of the BBB, it has recently been demonstrated that systemic treatment contributes to survival after brain metastasis [4,12,13,14]. The goal of the current study was to determine whether systemic treatment is efficacious in breast cancer patients with brain metastases with different biological subgroups.…”

Cisplatin Plus Gemcitabine for Treatment of Breast Cancer Patients with Brain Metastases: a Preferential Option for Triple Negative Patients?

“…Younger age (Tsukada et al, 1983;Carey et al, 2004), advanced stage (Carey et al, 2004;Ryberg et al, 2005), negative hormon receptor status (Samaan et al, 1981;Maki and Grossman, 2000) and HER2 overexpression (Gabos et al, 2006;Nam et al, 2008) are some of the reported risk factors for development of brain metastases. Survival after brain metastases is poor; it may be as short as 1-2 months for patients without treatment (DiStefano et al, 1979), while 8-10 months of survival times are reported for patients with systemic chemotherapy (Lee et al, 2008;Arslan et al, 2011;Kim et al, 2012). Although HER2 overexpression is a poor prognostic factor, the survival times of the HER2 positive patients with brain metastases treated with antiHER2 therapy (trastuzumab) are longer than the triple negative or HR(+) patients (Bendell et al, 2003;Kirsch et al, 2005;Nam et al, 2008).…”

“…Triple negative patients with brain metastases have the poorest prognosis compared to other biological subtypes . Median survival after central nervous system involvement in triple negative breast cancer (TNBC) patients are reported between 3.4-6.6 months (Eichler et al, 2008;Nam et al, 2008;Arslan et al, 2011). Due to the lack of hormon receptor and HER2 expression there is not any systemic treatment option except chemotherapy for TNBC.…”