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Lani · 10-13-2006, 02:49 AM

Primary breast cancer phenotypes associated with propensity for central nervous system metastases
Kadri Altundag, MD
Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
We congratulate Tham et al. for their retrospective study, in which they attempted to define an association between primary breast cancer phenotype and a propensity for central nervous system (CNS) metastases.[1] They demonstrated that younger patients with hormone receptor-negative, highly proliferative, genomically unstable, and p53-altered tumors were at an increased relative risk for CNS metastases. In their analysis, the median survival after a diagnosis of CNS metastases was 5.5 months in 383 patients. On univariate analysis, they did not find any association between survival and the clinicopathologic characteristics of the patients with the exception of HER-2 status. Patients with HER-2 overexpression were found to have a shorter survival.

A recent retrospective study evaluated clinical data from 420 patients who had been diagnosed with breast cancer and CNS metastases between 1994 and 2004 at the University of Texas M. D. Anderson Cancer Center. In this study, the median follow-up after a diagnosis of CNS metastases was 6 months (range, 0.7-95.9 months) and the overall median survival was 6.8 months.[2] On univariate analysis, patients with younger age, positive hormone receptor status, a single CNS metastatic lesion, and CNS metastases as the site of first metastases were found to have significantly better survival. However, only age at diagnosis and estrogen receptor (ER) status were found to be significantly associated with overall survival on multivariate analysis. Patients with ER-positive disease tended to have a longer overall survival compared with patients with ER-negative disease (P = .003). Patients age 50 years tended to have a longer overall survival compared with patients age >50 years(P = .047). HER-2 status was not included in this analysis because of the large amount of missing data associated with this characteristic.

In conclusion, although the survival of patients with breast cancer metastases to the CNS is generally poor, there are some long-term survivors reported, such as younger patients with hormone receptor-positive histology and a single CNS metastatic lesion. More aggressive treatment approaches may be considered for these patients.

References

1 Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer. 2006; 107: 696-704. Links
2 Altundag K, Bondy ML, Kau SW, et al. Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastases. Breast Cancer Res Treat. 2005; 94 ( Suppl 1): S143. Abstract 3056. Links

10-13-2006, 02:49 AM	#2
Lani Senior Member Join Date: Mar 2006 Posts: 4,780	Oops, Forgot The Letter. Here It Is: Primary breast cancer phenotypes associated with propensity for central nervous system metastases Kadri Altundag, MD Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey We congratulate Tham et al. for their retrospective study, in which they attempted to define an association between primary breast cancer phenotype and a propensity for central nervous system (CNS) metastases.[1] They demonstrated that younger patients with hormone receptor-negative, highly proliferative, genomically unstable, and p53-altered tumors were at an increased relative risk for CNS metastases. In their analysis, the median survival after a diagnosis of CNS metastases was 5.5 months in 383 patients. On univariate analysis, they did not find any association between survival and the clinicopathologic characteristics of the patients with the exception of HER-2 status. Patients with HER-2 overexpression were found to have a shorter survival. A recent retrospective study evaluated clinical data from 420 patients who had been diagnosed with breast cancer and CNS metastases between 1994 and 2004 at the University of Texas M. D. Anderson Cancer Center. In this study, the median follow-up after a diagnosis of CNS metastases was 6 months (range, 0.7-95.9 months) and the overall median survival was 6.8 months.[2] On univariate analysis, patients with younger age, positive hormone receptor status, a single CNS metastatic lesion, and CNS metastases as the site of first metastases were found to have significantly better survival. However, only age at diagnosis and estrogen receptor (ER) status were found to be significantly associated with overall survival on multivariate analysis. Patients with ER-positive disease tended to have a longer overall survival compared with patients with ER-negative disease (P = .003). Patients age 50 years tended to have a longer overall survival compared with patients age >50 years(P = .047). HER-2 status was not included in this analysis because of the large amount of missing data associated with this characteristic. In conclusion, although the survival of patients with breast cancer metastases to the CNS is generally poor, there are some long-term survivors reported, such as younger patients with hormone receptor-positive histology and a single CNS metastatic lesion. More aggressive treatment approaches may be considered for these patients. References 1 Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Cancer. 2006; 107: 696-704. Links 2 Altundag K, Bondy ML, Kau SW, et al. Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastases. Breast Cancer Res Treat. 2005; 94 ( Suppl 1): S143. Abstract 3056. Links