The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

Niwińska, Anna; Tacikowska, M.; Murawska, Magdalena

doi:10.1016/j.ijrobp.2009.06.030

Cited by 78 publications

(64 citation statements)

References 27 publications

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“…In patients with breast cancer and brain metastases, disease progression at other organs is often observed. 5,6,14 Therefore, there is a need for the introduction or continuation of systemic therapy after WBRT (20) 18 (20) 16 (14) 7 (7) .128…”

Section: Discussionmentioning

confidence: 99%

Breast cancer subtypes and response to systemic treatment after whole‐brain radiotherapy in patients with brain metastases

Niwińska

Murawska

Pogoda

2010

Cancer

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BACKGROUND:The aim of this study was to assess the role of systemic treatment after whole-brain radiotherapy (WBRT) in immunohistochemically defined biological subsets of breast cancer patients with brain metastases. METHODS: The group of 420 consecutive breast cancer patients with brain metastases treated at the same institution between the years of 2003 to 2009 was analyzed. Patients were divided into 4 immunohistochemically biological subsets, based on the levels of estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) receptors, and labeled as luminal A, luminal B, HER2, and triple-negative. Survival from brain metastases with and without systemic treatment after WBRT was calculated in 4 subsets. RESULTS: In the entire group, the median survival from brain metastases in patients without and with systemic treatment after WBRT was 3 and 10 months, respectively (P < .0001). In the triple-negative subset, the median survival from brain metastases with and without systemic treatment was 4 and 3 months (P ¼ .16), and in the luminal A subset, it was 12 and 3 months, respectively (P ¼ .003). In the luminal B subset, the median survival without further treatment, after chemotherapy and/or hormonal therapy, and after chemotherapy and/or hormonal therapy with targeted therapy was 2 months, 9 months, and 15 months, respectively (P < .0001). In the HER2 subset, the median survival was 4 months, 6 months, and 13 months, respectively (P < .0001). No significant response to systemic treatment was noted in the triple-negative breast cancer population. CONCLUSIONS: Systemic therapy, ordered after WBRT, appears to improve survival in patients with the luminal A, luminal B, and HER2 breast cancer subtypes. Targeted therapy was found to have an additional positive impact on survival. In patients with triple-negative breast cancer, the role of systemic treatment after WBRT appears to be less clear, and therefore this issue requires further investigation. Cancer 2010;116:4238-47.

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Section: Discussionmentioning

confidence: 99%

Breast cancer subtypes and response to systemic treatment after whole‐brain radiotherapy in patients with brain metastases

Niwińska

Murawska

Pogoda

2010

Cancer

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“…Badanie to zostało przedwcześnie zakończone w związku z korzyścią w zakresie PFS i OS w ramieniu TC w porównaniu z LC (mediana PFS odpowiednio 8 i 6,6 miesiąca [HR 1,3; 95% CI: 1,0-1,7]; mediana OS: 27,3 i 22,4 miesiąca [HR 1,58; 95% CI: 1,07-2,32]. Niezależnie od częstości występowania przerzutów do mózgu u chorych na HER2-dodatniego raka piersi oraz postępów w leczeniu aktywne poszukiwanie bezobjawowych zmian w mózgu nie wpływa na poprawę parametrów przeżycia i nie jest zalecane [42]. Postępowanie takie w praktyce klinicznej może wręcz utrudniać decyzje terapeutyczne, zwłaszcza jeżeli przed rozpoczęciem leczenia nie wykonano obrazowych badań mózgu.…”

Section: Systemowe Leczenie Chorych Na Her2-dodatniego Raka Piersi Z unclassified

Czy u chorych na HER2-dodatniego raka piersi z przerzutem do mózgu rozpoznanym w trakcie leczenia trastuzumabem należy zmienić lek? Głos na TAK

Duchnowska¹

2015

Nowotwory. Journal of Oncology

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We should change the current treatment in HER2-positive breast cancer patients with brain metastases developed during trastuzumab administration WstępRak piersi z nadmierną ekspresją lub amplifikacją genu HER2 ("HER2-dodatni") cechuje się szczególną agresywnością, przejawiającą się między innymi zwiększonym ryzykiem przerzutów do mózgu. Skumulowane 10-letnie ryzyko wystąpienia przerzutów do mózgu u chorych na HER2-dodatniego raka piersi jest blisko 3-krotnie wyższe niż u chorych na raka HER2-ujemnego (odpowiednio 2,6% i 0,9%) [1]. U chorych na HER2-dodatniego raka piersi skojarzenie chemioterapii lub hormonoterapii z monoklonalnym przeciwciałem anty-HER2, trastuzumabem, wydłuża czas wolny do nawrotu (diesease-free survival -DFS) oraz czas ogólnego przeżycia (overall survival -OS). Paradoksalnie, dłuższe przeżycie oznacza jednak także większe prawdopodobień-stwo ujawnienia się późnych przerzutów w mózgu. Zbiorcza analiza wyników badań, w których oceniano skuteczność trastuzumabu w uzupełniającym leczeniu, wykazała wzrost względnego ryzyka (relative risk -RR) przerzutów do mó-zgu o 57% (1,57; 95% zakres ufności [confidence interval -CI] 1,03-2,37; p = 0,033) [2]. Obserwację tę potwierdzono w danych z rejestru prowincji Parma: ryzyko izolowanych przerzutów do mózgu u chorych na HER2-dodatniego raka, którzy otrzymali leczenie trastuzumabem, wynosiło 4%, u nieleczonych 1,2%, a u chorych na raka HER2-ujemnego 0,6% (p = 0,035) [3]. W innej retrospektywnej obserwacji odsetek izolowanych przerzutów do mózgu u chorych otrzymujących trastuzumab w uzupełniającym leczeniu był także wyższy [4]. Z drugiej strony w rejestrze prowincji Parma czas do pojawienia się przerzutów do mózgu u chorych na HER2-

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“…11 In a series from Poland, investigators prospectively determined that, in patients with HER2-positive breast cancers, early detection of occult intracranial metastases reduced the rate of neurologic death from 48% to 16% (P 5 .009) but did not improve overall survival. 12 …”

Section: Clinical Disparities Between Symptomatic and Asymptomatic Mementioning

confidence: 99%

Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

Lester

Taksler

Kuremsky

et al. 2013

Cancer

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BACKGROUND:Insurers have started to deny reimbursement for routine brain surveillance with magnetic resonance imaging (MRI) after stereotactic radiosurgery (SRS) for brain metastases in favor of symptom-prompted imaging. The authors investigated the clinical and economic impact of symptomatic versus asymptomatic metastases and related these findings to the use of routine brain surveillance. METHODS: Between January 2000 and December 2010, 442 patients underwent upfront SRS for brain metastases. In total, 127 asymptomatic patients and 315 symptomatic patients were included. Medical records were used to determine the presenting symptoms, distant and local brain failure, retreatment, and need for hospital and rehabilitative care. Cost-of-care estimates were based on Medicare payment rates as of January 2013. RESULTS: Symptomatic patients had an increased hazard for all-cause mortality (hazard ratio, 1.448) and were more likely to experience neurologic death (42% vs 20%; P <.0001). Relative to asymptomatic patients, symptomatic patients required more craniotomies (43% vs 5%; P <.0001), had more prolonged hospitalization (2 vs 0 days; P <.0001), were more likely to have Radiation Therapy Oncology Group grade 3 and 4 post-treatment symptoms (24% vs 5%; P <.0001), and required $11,957 more on average to manage per patient. Accounting for all-cause mortality rates and the probability of diagnosis at each follow-up period, the authors estimated that insurers would save an average $1326 per patient by covering routine surveillance MRI after SRS to detect asymptomatic metastases. CONCLUSIONS: Patients who presented with symptomatic brain metastases had worse clinical outcomes and cost more to manage than asymptomatic patients. The current findings argue that routine brain surveillance after radiosurgery has clinical benefits and reduces the cost of care. Cancer 2014;120:433-41.

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The Effect of Early Detection of Occult Brain Metastases in HER2-Positive Breast Cancer Patients on Survival and Cause of Death

Cited by 78 publications

References 27 publications

Breast cancer subtypes and response to systemic treatment after whole‐brain radiotherapy in patients with brain metastases

Breast cancer subtypes and response to systemic treatment after whole‐brain radiotherapy in patients with brain metastases

Czy u chorych na HER2-dodatniego raka piersi z przerzutem do mózgu rozpoznanym w trakcie leczenia trastuzumabem należy zmienić lek? Głos na TAK

Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery

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