Characteristics of breast cancer patients with brain metastases who live longer than 18 months

Abstract

I want to congratulate Phillips et al. [ [1] Phillips C. Jeffree R. Khasraw M. Management of breast cancer brain metastases: a practical review. Breast. 2016; 31: 90-98 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ] for their review article about the management of breast cancer brain metastases published in the Breast. Although the survival outcome for patients with breast cancer metastatic to brain is generally poor, there were some long-term survivors. In one study, the authors retrospectively evaluated clinical data from 420 patients who had been diagnosed with breast cancer brain metastasis [ [2] Altundag K. Bondy M.L. Mirza N.Q. Kau S.W. Broglio K. Hortobagyi G.N. et al. Clinicopathologic characteristics and prognostic factors in 420 metastatic breast cancer patients with central nervous system metastasis. Cancer. 2007; 110: 2640-2647 Crossref PubMed Scopus (132) Google Scholar ]. Of these 420 patients, 82 patients (19.5%) were alive at least 18 months after diagnosis of brain metastasis. Of these 82 patients, 25 patients (30%) had HER-2-positive breast cancer. Interestingly, 18 patients (4.2%) were alive at least 60 months after this diagnosis. The median age of these relatively longer surviving patients was 42 years. Approximately 50% of these patients had ER-positive or PR-positive disease, and 73% had grade 3 disease. Forty-six percent of these patients had a single CNS metastasis. In summary, compared with an unselected series of breast cancer patients, long – term survivors were younger and predominantly were premenopausal. This group also included a higher proportion of patients with a single metastatic lesion and with brain as the first metastatic site. Compared with unselected breast cancer patients, these patients had a higher percentage of ER-positive tumors. Any or all of these characteristics may interpret their potential for longer survival. Management of breast cancer brain metastases: A practical reviewThe BreastVol. 31PreviewBrain metastases are a common, and frequently challenging, clinical problem in the contemporary management of metastatic breast cancer. While the management of extracranial metastatic breast cancer is now strongly defined by tumour phenotype, this approach is not so well defined for brain metastases. We review available evidence regarding management of brain metastases, including the limited breast-cancer-specific data. A framework for management according to breast cancer phenotype is proposed. Full-Text PDF Reply to Dr Altundag from the authors of ‘Management of breast cancer brain metastases; a practical review’The BreastVol. 34PreviewWe thank Dr Altundag for his interest in our review of the management of breast cancer brain metastases [1] and for drawing attention to the large case series from MD Anderson Cancer Centre (MDACC) of patients with breast brain metastases [2]. In this series, Dr Altundag and colleagues observed some patients to have long survival after development of BM and found phenotype and age to be significant predictors of prognosis, in keeping with the RTOG disease-specific Graded Prognostic Assessment [3]. Full-Text PDF