Abstract
Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80-100%: 68.4% vs. 57%, p 1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
Highlights
The incidence of brain metastases (BM) in breast cancer patients has increased in the last decades and has become a major factor in life expectancy and quality of life for many breast cancer patients [1,2].The evaluation of the National Cancer Register in Sweden showed that compared with the period1998–2000, patients diagnosed with a primary breast cancer during 2001–2003 were at a 17% increased risk of being admitted with brain metastases during follow-up, and patients diagnosed in 2004–2006 were at a 44% increased risk [3].The retrospective analysis of Darlix et al showed that 24.6% of patients with metastatic breast cancer develop Brain metastases (BM) in the course of the disease [4]
A total of 2589 patients were included in the analysis; 2009 had documented neurological symptoms, which would raise the suspicion of BM, and 580 did not have those neurological symptoms
The majority of the patients presented with a good performance status at the diagnosis of BM (Karnofsky index ≥80%: n = 655, 59%)
Summary
The incidence of brain metastases (BM) in breast cancer patients has increased in the last decades and has become a major factor in life expectancy and quality of life for many breast cancer patients [1,2].The evaluation of the National Cancer Register in Sweden showed that compared with the period1998–2000, patients diagnosed with a primary breast cancer during 2001–2003 were at a 17% increased risk of being admitted with brain metastases during follow-up, and patients diagnosed in 2004–2006 were at a 44% increased risk [3].The retrospective analysis of Darlix et al showed that 24.6% of patients with metastatic breast cancer develop BM in the course of the disease [4]. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, a lead time bias of the earlier diagnosis cannot be ruled out.
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