ASCO abstract: most important to STAY on herceptin once have brain mets!!!

[Lani]

Abstract No:
11507
Citation:
Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007: 11507
Author(s):
B. Nam, K. Lee, T. Kim, J. Ro
Abstract:
Background: Brain metastases (BM) occur in as many as one-third of patients with metastatic breast cancer (MBC). Incidences and prognoses by triple receptor subtypes in BM have not been well delineated. Methods: Retrospectively, prognoses were assessed according to clinical characteristics, triple receptor subtypes, and receipt of trastuzumab therapy by univariate and multivariate analyses. ER/PR/HER2 were tested by IHC with HER2 FISH for IHC 2+ and for all 118 consecutive primary BC. Results: Between 8/2001 and 4/2006, 138 of 805 pts (17.1%) with MBC presented with BM at NCC Korea. More pts with triple negative and HER2+ tumors developed BM (see table). The median age was 47 years. They were single (9%), multiple (80%), or leptomeningeal disease with or without multiple BM (11%). As initial therapy, 104 pts received WBRT, 8, intrathecal therapy (IT), 9, WBRT with IT, and 17 others. Of 56 HER2+ pts, 45 received trastuzumab either before (n=25) or after (n=13), or continuously before and after BM diagnosed (n=7). By 10/2006, 117 pts died with a median survival of 4.5 months. Multivariate analyses indicated age, tumor receptor subtypes, leptomeningeal presentation and number of extracranial disease sites as significant factors. Receipt of trastuzumab therapy after BM was a significant variable for survival in HER2+ diseases (3.8 vs. 13.4 mo, p=0.0000). Pts with triple negative subtype lived shortest compared with other types (p=0.0035). Conclusions: More pts with triple negative and HER2+ disease developed BM. HER2+ disease gained a significant survival benefit by trastuzumab therapy. Supported by NCC Grant 0610240 and 0510520.
Triple receptor status Brain metastasis
N (%) Metastatic breast cancer
N (%) Early breast cancer
N (%) P-value
ER or PR+/HER2- 23/126 (18.2) 254/556 (45.7) 68/118 (57.6) <0.0001
ER or PR+/HER2+ 19/126 (15.0) 73/556 (13.1) 16/118 (13.5)
ER and PR-/HER2+ 37/126 (29.4) 91/556 (16.4) 15/118 (12.7)
ER and PR-/HER2- 47/126 (37.3) 138/556 (24.9) 19/118 (16.1)
Unknown/total 12/138 111/667 0/118