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

Abstract

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.

Therapeutic approaches for HER2-positive brain metastases: Circumventing the blood–brain barrier

“…Median OS in patients with HER2-positive breast cancer who received trastuzumab- based therapy following the diagnosis of brain metastasis ranged from 9.0 to approximately 26 months compared with median OS ranging from 2.0 months to approximately 9 months in patients who did not receive trastuzumab (Table 1). 42,73–82 However it must be noted that the available data derive from post hoc and/or retrospective analyses (see Table 1). …”

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

“…Younger age, poorly differentiated primary tumours, negative hormone receptor (HR) status and axillary nodee positive breast cancer have been associated with increased BM risk. Patients with HER2-positive and triple-negative breast cancer have a higher risk of developing BMs than patients with luminal tumours [3,4]. In patients with metastatic HER2-positive or triple-negative disease, prevalence of BMs as high as 30e40% has been described [3e5].…”

Comparison of nine prognostic scores in patients with brain metastases of breast cancer receiving radiotherapy of the brain

“…With the improvement of diagnostic and treatment strategies in breast cancer patients with BM, historical PI might not reflect clinical reality anymore. Anti-HER2-based therapies, for example, have improved patient survival in HER2-positive patients with BM (Witzel et al 2011). Several of the parameters that are known to be associated with prognosis in breast cancer patients with BM are not part of the calculation in many PI.…”