Abstract
126 Background: HER2 overexpression is associated with a high risk for brain metastases in breast cancer. We aimed to study if the same correlation exists in gastric or oesogastric junction (OGJ) adenocarcinoma, where brain metastases are uncommon. Methods: We retrospectively reviewed data of patients treated at our institution for metastatic gastric or OGJ adenocarcinoma. We compared incidences with a Fisher’s exact test. Survival was analyzed by the Kaplan-Meier method. Results: Between 2007 and 2011, 74 patients were treated at our institution, 63 patients were analyzed for HER2 status. Median age was 62 (range: 22-81). There were 52 men (82.5%) and 11 women (17.5%). 36 patients (57.1%) had gastric cancer, 27 (42.9%) OGJ adenocarcinoma. After a median follow-up of 9.4 months, 52 patients progressed and 38 patients died. Median progression-free survival was 5.3 months and median overall survival was 15.9 months. 38 patients (60.3%) had hepatic metastases, 32 (50.8%) lymph node metastases, 20 (31.7%) peritoneal carcinomatosis, 12 (19.0%) lung metastases and 3 (4.8%) brain metastases. HER2 was overexpressed in 11 (17.5%) patients (confirmed by IHC in 58 patients, by FISH in 5 patients). Two HER2+ patients did not received trastuzumab. Three HER2+ patients (27.3%) had brain metastases, as compared with 0 (0%) HER2- patients (p=0.004). Control of brain metastases was obtained in all 3 patients with multimodal treatment (surgery for 1 patient, radiotherapy for 3 patients and trastuzumab-containing chemotherapy in 3 patients). Progression-Free Survival (PFS) was significantly higher in HER2+ patients treated with trastuzumab than in HER2- patients: median 9.4 months vs 5.0 months (p=0.049). There was no apparent difference in PFS or overall survival between patients with or without brain metastases, but the numbers are too small to conclude. Conclusions: In this retrospective single-center series, we showed an increased incidence of brain metastases in patients with HER2+ gastric or OGJ adenocarcinoma. Patients with brain metastases benefited from multimodal treatment. Prognosis of HER2+ patients treated with trastuzumab seems better than HER2- patients. These results need confirmation in a multicenter study.
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