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more on brain mets in her2+ metastatic breast cancer (prevention recommended)
ie, prophylactic MRIs, treatment with agents which cross the BBB:
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Brain metastases in HER2 positive metastatic breast cancer (MBC) patients
Citation: European Journal of Cancer Supplements Volume 4, No. 2, March 2006, page 165
R. Duchnowska1, B. Czartoryska-Arlukowicz2, B. Radecka3, B. Szostakiewicz4, A. Karpinska5, R. Dziadziuszko4, C. Szczylik1
1Military Institute of Medicine, Oncology, Warsaw, Poland
2Regional Cancer Center, Bialystok, Poland
3Regional Oncology Center, Opole, Poland
4Department of Oncology and Radiotherapy, Medical University, Gdansk, Poland
5Department of Clinical Oncology, Regional Oncology Hospital, Szczecin, Poland
Background: Several recent reports suggested relatively high risk of brain relapse in HER2-positive breast cancer patients. This phenomenon has been attributed to either an aggressive behavior of this tumor type and/or an increased survival following trastuzumab therapy without brain protection owing to insufficient penetration of this drug to CNS. In this study we assessed the risk of brain metastases in a large unselected series of HER2-positive MBC patients.
Material and Method: Study group included 173 consecutive HER2-positive (immunohistochemistry 3+ or FISH+) MBC patients from five Polish institutions. Patient age ranged from 30 to 81 years (median 49 years); 83 patients were premenopausal (47.9%), 88 – postmenopausal (50.9%) and in 2 patients menopausal status was unknown (1.2%). Dominant site of disease included viscera in 130 (75.1%), soft tissue in 21 (12.1%), bones in 19 (11.0%) and was unknown in 3 patients (1.7%). Data on ER/PR status were available for 151 patients (87.3%). ER+/PgR+, ER+/PgR-, ER-/PgR+, ER-/PgR- phenotypes were represented by 19.9%, 13.9%, 4.0% and 62.3% of this group, respectively. 66 patients (38.2%) had received prior (neo)adjuvant chemotherapy, 11 (6.4%) – adjuvant hormonotherapy, and 53 patients (30.6%) – a combination thereof. Disease-free interval to the development of MBC ranged between 0 and 124 months (median 14 months). A total of 126 patients (72.8%) received trastuzumab for MBC, usually in combination with chemo- and/or endocrine therapy. Statistical analysis included contingency tables, chi-square test, Kaplan-Meier survival analysis and Cox proportional hazard model.
Results: Median follow-up from the development of MBC was 3.8 years (range 0.5–12.3 years). 45 patients (26.0%) developed brain metastases including 26.2% and 25.5% who did and did not receive trastuzumab (p = 0.93). Median time to brain relapse from the diagnosis of MBC was 10 months (range, 0 to 65 months). Detailed analysis of factors related to the risk of CNS metastases will be presented during the conference.
Conclusion: HER2-positive MBC patients carry increased risk of brain relapse which does not seem to be reduced with trastuzumab treatment. This calls for more effective preventive measures.
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