Central Nervous System Metastasis in Patients with HER2-Positive Metastatic Breast Cancer: Patient Characteristics, Treatment, and Survival from SystHERs

Abstract

Purpose: Patients with HER2-positive metastatic breast cancer (MBC) with central nervous system (CNS) metastasis have a poor prognosis. We report treatments and outcomes in patients with HER2-positive MBC and CNS metastasis from the Systemic Therapies for HER2-positive Metastatic Breast Cancer Study (SystHERs). Experimental Design: SystHERs (NCT01615068) was a prospective, U.S.-based, observational registry of patients with newly diagnosed HER2-positive MBC. Study endpoints included treatment patterns, clinical outcomes, and patientreported outcomes (PRO). Results: Among 977 eligible patients enrolled (2012-2016), CNS metastasis was observed in 87 (8.9%) at initial MBC diagnosis and 212 (21.7%) after diagnosis, and was not observed in 678 (69.4%) patients. White and younger patients, and those with recurrent MBC and hormone receptor negative disease, had higher risk of CNS metastasis. Patients with CNS metastasis at diagnosis received first-line lapatinib more commonly (23.0% vs. 2.5%), and trastuzumab less commonly (70.1% vs. 92.8%), than patients without CNS metastasis at diagnosis. Risk of death was higher with CNS metastasis observed at or after diagnosis [median overall survival (OS) 30.2 and 38.3 months from MBC diagnosis, respectively] versus no CNS metastasis [median OS not estimable: HR 2.86; 95% confidence interval (CI), 2.05-4.00 and HR 1.94; 95% CI, 1.52-2.49]. Patients with versus without CNS metastasis at diagnosis had lower quality of life at enrollment. Conclusions: Despite advances in HER2-targeted treatments, patients with CNS metastasis continue to have a poor prognosis and impaired quality of life. Observation of CNS metastasis appears to influence HER2-targeted treatment choice.

Baseline Characteristics, Treatment Patterns, and Outcomes in Patients with HER2-Positive Metastatic Breast Cancer by Hormone Receptor Status from SystHERs

“…Disease history, previous cancer-related treatment data, and baseline patient and disease characteristics (some data previously reported [12,13]) were collected at enrollment. Treatments for MBC, disease progression, and clinical outcomes were captured quarterly from patient charts, diagnostic tests, laboratory findings, and clinical notes.…”

Characteristics and Clinical Outcome of Breast Cancer Patients with Asymptomatic Brain Metastases

“…A literature review performed by Komorowski et al shows that in particular patients with HER2-positive and triple-negative metastatic breast cancer have a high incidence of BM (ranging between 22% and 36% and 15% and 37%, respectively). Further risk factors for the development of BM among (HER positive) patients with metastatic breast cancer are younger age, progress of the metastatic breast cancer, and hormone receptor-negative disease [ 29 ]. There is less information available concerning risk factors for developing BM in patients with metastatic TNBC.…”

Neue Therapien in der Onkologie – Wirkweise und Nebenwirkungen

“…Die oftmals außergewöhnlich lange gut wirksamen neueren Therapien führen darüber hinaus zu einem weiteren Phänomen: Patienten präsentieren sich z. T. nach sehr langer Zeit unter wirksamer Therapie mit atypischen metastatischen Läsionen; häufig auch mit Befunden, die das zentrale Nervensystem betreffen, in dem sich Rezidive oder Progresse als parenchymatöse und/oder meningeale Metastasen oder durch metastatischen Liquorbefall manifestieren [11][12][13].…”