414PD - Is brain-only metastatic breast cancer a distinct entity?

Date 29 September 2012
Event ESMO Congress 2012
Session CNS tumors
Topics Breast Cancer, Metastatic
Central Nervous System Malignancies
Presenter Anna Berghoff
Authors A.S. Berghoff1, Z. Bago-Horvath2, G.G. Steger3, C. Zielinski4, R. Bartsch3, M. Preusser5
  • 1Institute Of Neurology, Medical University of Vienna, 1090 - Vienna/AT
  • 2Institute Of Pathology, Medical University of Vienna, 1090 - Vienna/AT
  • 3Department Of Medicine I, Clinical Division Of Medical Oncology, Medical University of Vienna, Vienna/AT
  • 4Department Of Medicine I, Medical University of Vienna, 1090 - Vienna/AT
  • 5Department Of Medicine I, Medical University of Vienna, Vienna/AT

Abstract

Background

Up to 40% of metastatic breast cancer patients (pts) are diagnosed with brain metastases (BM) during their course of diseases. Some case reports and small patient series have indicated that breast cancer pts with the brain as only metastatic site (“brain-only”) may have a more favourable prognosis than BM pts with more widespread metastatic disease.

Methods

We identified all breast cancer pts with BM treated at our institution between 1990 and 2011. For each patient, full information on follow up and administered therapies was mandatory for inclusion. Estrogen-receptor (ER), progesterone-receptor and HER2 status were determined according to standard protocols. We performed statistical analyses including computation of survival probabilities.

Results

Overall, 223 female pts (26.0% luminal subtype; 47.5% HER2 subtype; 26.5% triple negative subtype) with BM of metastatic breast cancer were included in this study. In 60/223 pts (26.9%) the brain was the first metastatic site. Brain as first metastatic site was significantly less common in the HER2-positive subtype than in luminal and triple negative subtypes (p = 0.005). 38/223 (17%) of BM pts did not develop extracranial metastases (ECM) during their disease course and were classified as “brain-only” cases. Brain-only metastatic behaviour was not associated with breast cancer subtype or number of BM. The median OS of the brain-only pts was 11 months (range 0-69) and was significantly longer than in pts with BM and ECM (5 months, range 0 to 104) (p = 0.007). High KPS (p = 0.02), single BM (p < 0.001) and ER expression (p = 0.014) were associated with favourable OS in the brain-only cohort. 7/38 (18.4%) brain-only pts had long-time survival of more than 3 years after diagnosis of BM.

Conclusions

Among breast cancer pts with BM, brain-only metastatic behaviour is not associated with breast cancer subtype, but with favourable survival prognosis. Exploitation of all multimodal treatment options is warranted in breast cancer pts with brain-only metastatic disease, as long-term survival is not uncommon in this patient population.

Disclosure

All authors have declared no conflicts of interest.