The prognostic contribution of clinical breast cancer subtype, age, and race among patients with breast cancer brain metastases

Abstract

Background Brain metastases (BM) arising from Triple-negative breast cancer (TNBC) portend poor prognosis. TNBC is more common in premenopausal and African-American (AA) patients; both also confer poor prognosis. In a single institution cohort study, we sought to determine if inferior outcome of TN BCBM is more reflective of a higher-risk population or subtype itself. Methods The UNC Breast Cancer Database identified pts with BCBM diagnosed 1988 – 2008. BC subtype was assigned by IHC: HR+ (hormone receptor, ER+ and/or PR+)/HER2−, HR+/HER2+, HR−/HER2+ and TN (ER−/PR−/HER2−). Survival and recurrence patterns were evaluated by subtype, age (< vs ≥ 40 years) and race (AA vs non-AA) using the Kaplan-Meier method and Cox regression. Results Among 119 patients with BCBM, 33% were AA and 31% aged < 40 yrs. BC subtype was confirmed in 98 patients: 30% HR+/HER2−, 21% HR+/HER2+, 18% HR−/HER2+, 31% TN. Survival after BM was impacted by subtype (p=0.002), shortest for TNBC (0.24 yrs, CI 0.17 – 0.48). There were no age- (p=0.84) or race-specific (p=0.09) differences in survival after BM; stratification of subtypes by age and race revealed no difference (all, p > 0.1). Receipt of systemic therapy after BCBM was an important predictor of survival following BCBM (HR = 0.29, p=0.002) when adjusted for race, age, number of CNS lesions and BC subtype. Conclusions TNBC confers a high risk of death following BM regardless of race and age supporting the need for novel agents capable of controlling both intra- and extracranial TNBC across all races and ages.

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

“…A number of studies have reported a significantly longer survival time for patients with BM in HER2-overexpressing breast cancer (17)(18)(19). In the present analysis, a non-significantly prolonged median survival time of patients with HER2-positive disease was observed.…”

CNS Metastases in Breast Cancer: Old Challenge, New Frontiers

“…Unfortunately, survival from CNS metastases in patients with triple-negative breast cancer remains dismal (less than 6 months; refs. 19,21,22).…”

Incidence of brain metastases as a first site of recurrence among women with triple receptor-negative breast cancer.

“…In a single institution study of over 3000 women Hietz et al (29) reported a higher odds of developing brain metastases among women with TNBC (OR:4.16; 95%CI:2.26-7.64; p<0.001) compared to other breast tumor subtypes. Following a diagnosis of brain metastases, several studies have documented poor survival outcomes across all subtypes of breast cancer with TNBC exhibiting a worse outcome (16,19,(30)(31)(32)(33). Looking at a cohort of 99 patients with breast cancer and brain metastases, Carey et al (33) reported that patients with TNBC had the shortest survival (0.24 years) compared to other subtypes.…”

“…Following a diagnosis of brain metastases, several studies have documented poor survival outcomes across all subtypes of breast cancer with TNBC exhibiting a worse outcome (16,19,(30)(31)(32)(33). Looking at a cohort of 99 patients with breast cancer and brain metastases, Carey et al (33) reported that patients with TNBC had the shortest survival (0.24 years) compared to other subtypes. Our own group recently reported an overall survival of 2.9 months following a diagnosis of brain metastases at any time point among women with TNBC and 5.8 months among women with this subtype who developed brain metastases as a first site of recurrence (19).…”