[RobinP]

Hi Rozebud,

I actually read almost every abstract from the SABC this year. I do recall one abstract stating that the phenophyte for increased brain mets was high grade tumors and er, pr negative, NOT her2. Having said that, I also read that once you have a her2+ recurrence, then you are more likely to reoccur thereafter in the brain.

I do get yearly MRI, but I was thinking even more frequent MRI would be nice. This is especially true when I just read of a her2+ bc patient would had a clear cat scan only 4 months prior to multiple nodules of brain met. LOL, help us.


3020] Breast cancer phenotype associated with a propensity for central nervous system (CNS) metastases.

Tham YL, Sexton K, Kramer R, Hilsenbeck S, Elledge R. Baylor College of Medicine, Houston, TX

Background: There is anecdotal evidence that the incidence of CNS metastases has increased with the advancement of systemic therapy, such as trastuzumab. However, it is unclear whether either specific tumor biological properties or systemic therapies influence the risk of CNS metastases. Furthermore, the identification of a tumor phenotype with a propensity for CNS metastases would be important for future screening or preventive strategies.
Methods: Using a database of 10782 patients that were diagnosed and treated from 1970 to 1999, 2685 patients were identified who relapsed distantly. Clinical and biological features of these patients were analyzed in two groups: 1) Patients who ever had CNS metastases (14%, n=383) were compared with those who never had CNS metastases (86%, n=2302) and 2) Patients who had CNS metastases as the first site of relapse (39%, n=150) vs. those who had other sites (61%, n=233). Survival after CNS metastasis was calculated using the Kaplan-Meier method and this was correlated with clinical and biological features of the patients.
Results: In the ever versus never analysis, factors associated with CNS metastases were young age (p<0.001), premenopausal status (p=0.008), ER and PR negative tumor (p<0.001), high S-phase (p=0.002), aneuploidy (p=0.02), and altered p53 (p=0.01). ILC was less likely to be associated with CNS metastases (p=0.01). Tumor size and lymph node status were not associated with a relative increase in risk of CNS metastases compared with other sites. Adjuvant systemic therapy also did not alter the relative risk of CNS vs. non-CNS metastases when compared with patients that did not receive therapy. Her2 positivity was not associated with CNS metastases in these patients, all of whom were treated prior to the trastuzumab era (p=0.91), though Her2+ patients were more likely to develop CNS metastases following non-CNS relapse (p=0.04). The biomarker profile of CNS failure as first recurrence did not otherwise differ from those with CNS metastases as subsequent recurrence. In a multivariate analysis of the above factors, ER negativity (OR 2.8, p<0.001), IDC histology (OR 2.5, p=0.02), and young age (p<0.001) were independent factors associated with any CNS metastases. The median survival after CNS metastases was 5.5 months, with 25% of the patients alive at one year and 10% at 2 years. The only factor that significantly influenced survival was Her2 status, with Her2 positive patients having a shorter survival (p=0.02).
Conclusion: Younger patients with hormone receptor negative tumors that are highly proliferative, genomically unstable, and p53 altered are at increased relative risk for CNS metastases. Her2 expression did not increase the relative risk of CNS metastases in the absence of trastuzumab therapy. Adjuvant therapies did not change the patterns of distant recurrence.

Friday, December 9, 2005 5:00 PM