Incidence, pattern and prognosis of brain metastases in patients with metastatic triple negative breast cancer

Abstract

BackgroundTo identify the incidence, recurrence pattern and prognosis of brain metastases (BM) among women with metastatic triple negative breast cancer (mTNBC) treated consecutively at a single institution during a 7-year period.MethodsPatients with histologically confirmed mTNBC were retrospectively identified. The incidence of BM as first site of recurrence and the cumulative BM incidence were computed. We used the Cox proportional hazards model to identify the univariate and multivariate factors associated with survival.ResultsFour hundred thirty three patients were included with a median overall survival (OS) of 21.6 months after median follow-up for 48.1 months. BM was found in 29% (127/433) of the patients and about a quarter (32/127) of BM was first recurrence. The cumulative incidence of BM at 1 and 2 years was 17 and 25%, respectively. The median time from the diagnosis of extracranial metastases to BM was 10 months. Median OS following a diagnosis of BM was 7.3 months. The longer median OS from time of first recurrent BM was noted compared with those of subsequent recurrent (17.3 vs 6.3 months, p = 0.008). However, patients with first recurrent BM were associated with shorter OS compared with those without BM (17.3 vs 22.1 months, p = 0.006). The independent factors that increased BM death risk were > 3 brain lesions, no BM-directed treatment, subsequent recurrent BM, symptomatic BM and uncontrolled extracranial metastasis.ConclusionsPatients with mTNBC have a high incidence of early BM with subsequent poor survival. The findings lend support to consideration of screening imaging of the brain for mTNBC patients.

Frequency of Brain Metastasis in Breast Cancer Patients and Factors Leading to it

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Effect of metastatic site on survival in patients with neuroendocrine neoplasms (NENs). An analysis of SEER data from 2010 to 2014

“…A study in two major institutions [27] in carcinoid patients with bone and/or liver metastases confirmed that coexistence of bone and liver metastasis was indicative of worse prognosis with a significant difference in overall survival -the small total numbers of patients (691) might have made it more difficult to obtain statistical significance in other histologies. The poor prognosis of brain metastases is not unexpected and is consistent across different tumor types, such as breast [28,29], lung [30], gastrointestinal [31] and ovarian [32]. It is usually measured in matters of months and may reflect the virulence of the tumor, the severity of CNS dysfunction or the inability of most current therapies to cross the blood brain barrier.…”

microRNAs Orchestrate Pathophysiology of Breast Cancer Brain Metastasis: Advances in Therapy

“…Around 25% of BC cases show HER2 amplification, and out of these, 30-55% of patients develop BM with a median survival of only 4-14 months [5,6]. Furthermore, TNBC patients with ER -/PR -/ HER2status are at high risk of BM recurrence [7].…”