Factors influencing the time to development of brain metastases in breast cancer

Fromm, Sabine; Bartsch, Rupert; Rudas, Margaretha; Vries, A. de; Wenzel, Catharina; Steger, Guenther G.; Zielinski, Christoph; Poetter, Richard; Dieckmann, Karin

doi:10.1016/j.breast.2008.03.008

Cited by 8 publications

(15 citation statements)

References 30 publications

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“…Thisfindingisconsistentwiththefindingsofapreviousstudy [13]. The significant influence of palliative systemic therapy, however,wasasomewhatunexpectedresult,asconventional chemotherapeuticdrugsarecommonlynotbelievedtoreach sufficient concentrations in brain tissue and cerebral spinal fluid,duetotheblood-brainbarrier [1].Thisresultshouldbe interpreted with some care, as the selected treatments were highlydependentonthediseasestatus.Thedefiniteexplanationfortheinfluenceofpalliativesystemictherapyremainsa matterofsomecontroversyandshouldbefurtheraddressed inaprospectivefashion.…”

Section: Discussionsupporting

confidence: 63%

“…AgreatdealofstudyhasbeenconductedthusfartoidentifythesubgroupsofpatientsathighriskofdevelopingBM who would benefit from early detection and/or prevention [3,13,14]. It has been recently demonstrated that gene expressionprofilingcanpredictdisease-freeandoverallsurvival inwomenwithprimarybreastcancer,andseveralnovelcan- Ourstudyhasseverallimitations.First,itwasaretrospective study; in some cases, follow-up was incomplete.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes and Breast Cancer Subtypes in Patients with Brain Metastases

Kwon

Kim

et al. 2010

Onkologie

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Background: The principal objective of this study was to assess clinical outcomes by breast cancer subtype in patients with brain metastases. Methods: Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status was evaluated via immunohistochemical staining. Four survival time intervals were compared according to the subtype (ER+/HER2–, HER2+, triple negative (TN)). Results: 20 (30.3%) of the 66 patients in this study were ER+/HER2–, 20 (30.3%) were HER2+, and 26 (39.4%) were TN. The disease-free survival rates of ER+/HER2–, HER2+, and TN patients were 30.0, 17.0, and 17.9 months, respectively (p = 0.040). The median time intervals from distant metastasis to brain metastasis were 20.6, 19.5, and 9.0 months, respectively (p = 0.012). The times from initial diagnosis to brain metastasis were 52.9, 33.6, and 25.5 months, respectively (p = 0.026). However, the overall survival rates did not differ significantly (p = 0.276). Conclusions: Patients with TN breast cancer were more likely to develop distant metastasis earlier, and also evidenced poor overall survival. Triple receptor status may be employed as a prognostic marker for breast cancer patients with brain metastases.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Breast Cancer Subtypes in Patients with Brain Metastases

Kwon

Kim

et al. 2010

Onkologie

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“…Apotentialdrawbackofourstudyisthatwewerenotableto compare our results with a HER2-negative patient cohort. However, the proportion of trastuzumab-treated patients is higherthaninotherstudies [3,[25][26][27].Ourpatientselection was based on trastuzumab treatment for MBC, whereas in otherstudiestheselectionwasbasedonradiotherapyforBM [12,24,26,28]orontheexistenceofBM [3,14,25,27,[29][30][31][32]. Thiscomplicatesthecomparabilityofresults.Nevertheless,a feature of several studies about BM in patients treated with trastuzumabisthefavourableprognosisofpatientsafterdiagnosis of MBC [8,14].…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective analysis of 174 HER2-positive and -negativeMBCpatientswithBMreceivingwholebrainradiotherapy, Fromm et al [24] postulated the hypothesis that trastuzumab treatment itself might shorten the time to the development of BM. But trastuzumab-treated patients may beoverrepresentedinthiscohortduetotheiroverallbetter survivalrates,orHER2overexpressionmaybeariskfactor forBMitself [3].…”

Section: Discussionmentioning

confidence: 99%

Management of Patients with Brain Metastases Receiving Trastuzumab Treatment for Metastatic Breast Cancer

et al. 2011

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Background: With the more effective control of visceral metastases in patients with metastatic breast cancer (MBC), an increasing number of patients face brain metastases (BM). The aim of this retrospective analysis was to investigate the incidence and factors affecting the prognosis of patients with BM under trastuzumab treatment for MBC. Patients and Methods: A total of 75 HER2positive patients treated with trastuzumab for MBC were included. Results are discussed in the context of the current literature. Results: Patients who developed BM (n = 29) had longer median progression-free survival (PFS) during first-line chemotherapy and longer overall survival (OS) after diagnosis of MBC than 46 patients without BM (PFS: 27 vs. 14 months, p = 0.039; OS: 46 vs. 18 months, p = 0.067). Median survival of patients with continuation of trastuzumab after diagnosis of BM was longer than survival of patients with discontinuation of trastuzumab treatment after BM (18 vs. 3 months, p = 0.006). Survival of patients who were treated with surgery and radiotherapy for BM was better compared with radiotherapy alone (9 vs. 5 months, p = not significant) or best supportive care (9 vs. 2 months, p = 0.049). Conclusions: Continuation of trastuzumab treatment as well as resection of BM seem to give further benefit in the treatment of patients with HER2-overexpressing MBC.

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“…Slimane et al [216] found lung metastasis as the first site of relapse and negative hormone receptor status risk factors for brain metastasis in breast cancer patients, although other studies included young age, tumor size, stage, tumor grade, histology, and human epidermal growth factor receptor 2 (HER2, also known as neu) [187,193,[217][218][219][220][221]. Overexpression of HER2 is repeatedly supported as a risk factor for brain metastasis in breast cancer patients [57,175,193,221,222], and the risk has increased since the development of trastuzumab (Herceptin; Genentech, San Francisco, CA), a monoclonal antibody therapy [57].…”

Section: Risk Factorsmentioning

confidence: 99%