Abstract
This study aimed to estimate the incidence of central nervous system (CNS) metastases in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) treated with trastuzumab.Studies were identified through a literature search of electronic databases. Random-effects meta-analyses were performed to estimate the incidence rate of CNS metastases, trastuzumab therapy duration, and time from trastuzumab therapy to CNS metastasis diagnosis. A meta-analysis of odds ratios was performed to evaluate the significance of a difference in CNS metastasis incidence between patients with and without trastuzumab treatment.Thirty studies (8121 trastuzumab-treated and 3972 control patients) were included. The follow-up duration was 18.9 months (95% confidence interval [CI]: 13.8, 24.1). The trastuzumab treatment duration was 9.0 months (95% CI: 7.0, 11.0). The median interval between the start of trastuzumab therapy and CNS metastasis diagnosis was 12.2 months (95% CI: 9.5, 14.7). The incidence of CNS metastasis after the start of trastuzumab therapy was 22% (95% CI: 16, 27). The incidence of CNS metastases was significantly higher in trastuzumab-treated than in non-trastuzumab-treated patients (odds ratio: 1.39 [95% CI: 1.06, 1.82], p=0.02). The survival time from the start of the study was 23.4 months (95% CI: 19.7, 27.1) in trastuzumab-treated patients and 18.4 months (95% CI: 12.7, 24.1) in patients treated with control regimens. The survival time after the development of CNS metastases in trastuzumab-treated patients was 19.2 months (95% CI: 15.6, 25.9).Approximately 22% of patients with HER2-positive MBC who were treated with trastuzumab developed CNS metastases. However, trastuzumab-treated patients had a longer survival than patients who were not treated with trastuzumab.
Highlights
Breast cancer is the second leading cause of cancer-related deaths in women, with a mortality rate of 2.6% in female patients [1]
8121 patients with human epidermal growth factor receptor-2 (HER2)-positive MBC were treated with trastuzumab with or without chemotherapy, and 3972 control patients received treatments without trastuzumab
The percentage of estrogen receptor-positive patients was 47% and that of progesterone receptor-positive patients was 38%
Summary
Breast cancer is the second leading cause of cancer-related deaths in women, with a mortality rate of 2.6% in female patients [1]. It accounts for 15.3% of all new cancer cases and 7% of all cancer mortalities. It is estimated that approximately 13% of women will be diagnosed with breast cancer during their lifetime [2]. The prognosis of breast cancer has improved, it is associated with an increased risk of metastases in the central nervous system (CNS), especially in the brain.
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