Prolonged survival after diagnosis of brain metastasis from breast cancer: contributing factors and treatment implications

Abstract

Objective: The prognosis of breast cancer-derived brain metastasis is poor, but new drugs and recent therapeutic strategies have helped extend survival in patients. Prediction of therapeutic responses and outcomes is not yet possible, however. In a retrospective study, we examined prognostic factors in patients with breast cancer-derived brain metastasis, and we tested the prognostic utility of a breast cancer-specific Graded Prognostic Assessment in these patients. Methods: Sixty-three patients diagnosed with brain metastasis from breast cancer treated surgically and adjuvantly were included. We examined clinical variables per primary tumor subtype: ER+/HER2 − (luminal), HER2+ (human epidermal growth factor receptor type 2-enriched) or ER−/PR−/HER2− (triple negative). We also categorized patients' breast cancer-specific Graded Prognostic Assessment scores and analyzed post-brain metastasis survival time in relation to these categories. Results: The breast cancers comprised the following subtypes: luminal, n = 18; human epidermal growth factor receptor type 2-enriched, n = 27 and triple-negative, n = 18; median survival per subtype was 11, 37 and 3 months, respectively. Survival of human epidermal growth factor receptor type 2-enriched patients was longer, though not significantly (P = 0.188), than that of luminal patients. Survival of triple-negative patients was significantly short (vs. human epidermal growth factor receptor type 2-enriched patients, P < 0.001). Karnofsky performance status, HER2 status and the disease-free interval (from initial treatment to first recurrence) were shown to be significant prognostic factors (Karnofsky performance status < 70: relative risk 2.08, P = 0.028; HER2+: relative risk 2.911, P = 0.004; disease-free interval < 24 months: relative risk 1.933, P = 0.011). Breast cancer-specific Graded Prognostic Assessment scores reflected disease-free intervals and survival times. Conclusions: Our data indicate that breast cancer-specific Graded Prognostic Assessment-based prediction will be helpful in determining appropriate therapeutic strategies for patients with brain metastasis from breast cancer.

Breast Cancer Subtypes and Mortality of Breast Cancer Patients With Brain Metastasis at Diagnosis: A Population-Based Study

“…2 Breast cancer-specific outcomes reflect the disease-free interval and OS interval. 25 Therefore, we analyzed OS according to breast cancer subtype among patients with BM, which revealed that the HR+/HER2+ subtype was associated with the longest median OS (19 months), while the HR–/HER2– subtype was associated with the shortest median OS (6 months). Patients with BM might benefit from increased surveillance and radiotherapy.…”

Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms

“…Other researchers have found that poor performance status is associated with a higher frequency of CNSm 30 ; nonetheless, this score might be associated with more extensive disease and not only due to CNSm itself. Finally, the main sites of extracranial metastases that relate to the onset of CNSm are reported to be the lung, bone, lymph nodes, and liver 31,32 .…”

Applications of Extracellular Vesicles in Triple-Negative Breast Cancer

“…About one third of TNBC patients will receive a diagnosis of brain metastasis, representing the end-stage of the disease as no cure is available to date. For these patients, the median survival has been reported as low as three to four months after diagnosis [ 14 , 15 ]. Furthermore, chemotherapeutic resistance and enrichment of cancer stem cells after chemotherapy are very common manifestations in TNBC patients, increasing the likelihood of metastasis and tumorigenesis [ 16 , 17 ].…”