Abstract
The development of brain metastases (BMs) in breast cancer (BC) patients remains a challenging complication. Current clinical practice guidelines recommend local treatment of BMs without changing systemic therapy (CST) in patients with stable extracranial disease. We retrospectively investigated the impact of CST (when applicable as per treating physician’s discretion) following the diagnosis and management of oligometastatic (1–3) BMs in patients without extracranial metastases on the progression-free survival time (PFS), and overall survival (OS). Hazard ratios (HRs) were calculated using the Cox proportional hazard model. Among the 2645 patients with BC and BMs treated between 2002 and 2015, 74 were included for analysis. 40.5% of patients had HER2 + disease. Median time from diagnosis of BC to BMs was 17.6 months. 54%, 8%, and 38% of BMs were managed by radiation, craniotomy, or combination, respectively. Following the primary management of BMs, we observed that CST occurred in 26 (35.5%) patients, consisting of initiation of therapy in 13.5% and switching of ongoing adjuvant therapy in 22%. Median PFS was 6.6 months among patients who had CST compared to 7.1 months in those who did not (HR = 0.88 [0.52–1.47], p = 0.62). Median OS was 20.1 months among patients who had CST compared to 15.1 months in those who did not (HR = 0.68 [0.40–1.16], p = 0.16). Upon the successful local management of oligometastatic BMs in patients without extracranial disease, we did not find a significant difference in survival between patients who experienced a change in systemic therapy as compared to those who did not.
Highlights
Despite advances in systemic therapies and improved overall survival of metastatic breast cancer (MBC) patients, the development of brain metastases (BMs) remains a challenging complication in 10–20% of patients and affects the quality of life and increases morbidity and mortality[1,2]
The subtype distribution in our study showed 40% human epidermal growth factor receptor 2 (HER2)+ and 28% triple negative (TN), which is compatible with a study published previously by our group from a larger cohort of 873 patients with BMs showing 39.4% HER2+ and 34.1% TN subtypes
Patient information was collected from the electronic medical record database, including demographics, histological type, hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, number of BMs, lack of extracranial disease at the time of BMs diagnosis, date of BMs diagnosis and subsequently confirmed disease progression in the brain or extracranially, the local therapy patients received after BMs diagnosis, the systemic therapy changes after BMs diagnosis and clinical outcomes
Summary
Despite advances in systemic therapies and improved overall survival of metastatic breast cancer (MBC) patients, the development of brain metastases (BMs) remains a challenging complication in 10–20% of patients and affects the quality of life and increases morbidity and mortality[1,2]. All patients had staging imaging documenting lack of extracranial metastases at the time of local therapy of BMs. Median OS for all patients was 16.8 months (95% CI: 13.7–27.1).
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