Brain MRIs for early stage....consensus??

[Rozebud]

Christine/Joe/others:

Given the article posted about brain mets being twice as common (my math in the small study was that it was 2.5x as common) in her2 cancers, should those of us that are "early stage" (so my onc keeps telling me, even though I'm stage 3C) who have never had mets be pushing for brain MRIs in absence of symptoms?

[saleboat]

Hi Rose,

I've wondered the same thing as well. Is there any reason to believe that early treatment of brain mets, before the presentation of symptoms, would be advantageous? If so, then maybe there's an argument for taking a closer look. Otherwise, I'm of the 'ignorance is bliss' school of thought. If I have to go back into treatment eventually, I'd rather not spend my healthy days looking for trouble, if you know what I mean. (I was also staged at 3C)

I'm interested to know what others think on this topic. If catching brain mets early means less-invasive treatment, then maybe there's an argument for proactively scanning women who had early stage disease. Things are never black and white though, are they?

Thanks,
Jen

[Becky]

I was able to have my onco agree to give me a prescription to get a brain MRI when I see him in a month based on the SABCS paper on Her 2 women having 2X the chance of brain mets (even early stage). He said he would recommend a brain MRI yearly to all his HER 2 women that are not metastatic.


It was that easy for me.

Best regards

Becky

PS - I am going to get it done.

[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

[Rozebud]

Robin - CNS = brain mets? Interesting article. Are there other good ones from SA you'd recommend? There were just too many for me to sift through! (Aren't there like 100?)

Jen - to answer your question, yes, gamma knife is much easier to tolerate on your brain if you have just one or two mets vs. WBR (whole brain radiation). The latter can only be used one time in your life as well. Hopefully Joe or christine will weigh in.

[StephN]

Dear Robin -
At the Symposium there is an area where the posters are blown up and mounted on large boards. Ms. Tham was at hers for discussion and Ginger and I happened to zero in on that one.
As stage IV survivors maintained on Herceptin we asked her if anyone like us was included and she said "no." The time period involved is really Pre-Heceptin and she felt that this would be a separate group that would need its own study. The fact that more of us are able to survive through the other distant mets leaves us open to a higher chance of CNS (Brain) mets.

In other words Ms. Tham felt that not enough patients on Herceptin were included in her large number to make a difference.

She was interested that we stopped to introduce ourselves and take in her study results. She seemed to be more of a statistician than one who deals directly with patients - MHO.

This was a HOT topic.