364P - Treatment outcomes and prognostic factors for patients with brain metastases from breast cancer: A multicenter cohort analysis

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Breast Cancer
Presenter Norikazu Masuda
Citation Annals of Oncology (2014) 25 (suppl_4): iv116-iv136. 10.1093/annonc/mdu329
Authors N. Masuda1, N. Niikura2, N. Hayashi3, S. Takashima4, R. Nakamura5, K. Watanabe6, C. Kanbayashi7, M. Ishida8, Y. Hozumi9, M. Tsuneizumi10, N. Kondo11, Y. Naito12, Y. Honda13, A. Matsui14, T. Fujisawa15, R. Oshitanai16, H. Yasojima1, Y. Tokuda17, S. Saji18, H. Iwata19
  • 1Surgery And Breast Oncology, NHO Osaka National Hospital, 5400006 - Osaka/JP
  • 2Breast And Endocrine Surgery, okai University School of Medicine, Kanagawa/JP
  • 3Breast Surgery, St. Luke's International Hospital, Tokyo/JP
  • 4Breast Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama/JP
  • 5Breast Surgery, Chiba cancer center Hospital, Chiba/JP
  • 6Breast Surgery, Hokkaido Cancer Center, Sapporo/JP
  • 7Breast Oncology, Niigata Cancer Center Hospital, Niigata/JP
  • 8Breast Oncology, National Kyushu cancer center, Fukuoka/JP
  • 9Surgery And Breast Oncology, Jichi Medical University, Utsunomiya/JP
  • 10Surgery And Breast Oncology, Shizuoka General Hospital, Shizuoka/JP
  • 11Breast Oncology, Aichi Cancer Center Hospital, Nagoya/JP
  • 12Breast And Medical Oncology, National Cancer Center Hospital East, Kashiwa/JP
  • 13Breast Surgery, Cancer and Infectious disease center Tokyo Metropolitan Komagome hospital, Tokyo/JP
  • 14Surgery, NHO Tokyo Medical Center, Tokyo/JP
  • 15Breast Surgery, Gunma Prefectural Cancer Center, Ohta/JP
  • 16Breast And Endocrine Surgery, Tokai University School of Medicine, Kanagawa/JP
  • 17Breast And Endocrine Surgery, Tokai University School of MedicineIsehara Campus, JP-259-1193 - Isehara/JP
  • 18Target Therapy Oncology, Kyoto University Graduate School of Medicine, Kyoto/JP
  • 19Breast Oncology, Aichi Cancer Center, 464-8681 - Nagoya/JP

Abstract

Aim

Brain metastases (BM) are associated with impaired quality of life and have an increasing problem in the management because of progressive neurological impairments. Although BM are less common in patients (pts) with breast cancer, they are associated with considerably poorer prognosis and are less responsive to systemic therapies. Recently, a trend of increased incidence of BM has been noted. To define prognostic factors for BM, compare their clinical courses and prognoses according to the subtypes, and analyze the causes of death.

Methods

We retrospectively collected cohort data for 1466 pts diagnosed with BM between 2001 April and 2012 December from 24 institutions of the breast division of the Japan Clinical Oncology Group (JCOG).

Results

After exclusion 210 pts' data due to the lack of enough data, overall 1256 pts with BM were evaluated. The median overall survival (OS) was 8.7 months (m) (95% CI, 7.8–9.6). Univariate and multivariate analyses revealed that pts with BM within 6 m of metastatic breast cancer diagnoses, asymptomatic brain disease, or HER2-positive/ER-positive tumors had increased OS. Median OS after BM was 9.3 m (95% CI, 7.2–11.3) for the luminal type, 16.5 m (11.9–21.1) for the luminal-HER2 type, 11.5 m (9.1–13.8) for the HER2 type, and 4.9 m (3.9–5.9) for the triple-negative type. The duration from MBC diagnosis until BM was longer in pts with luminal-type tumors than in pts with luminal-HER2 (HR = 1.24, P= 0.03), HER2 (HR = 1.83, P < 0.0001), and triple-negative (HR = 2.00, P < 0.0001). Luminal-HER2 pts had significantly longer OS than pts with the luminal (HR = 1.50, P< 0.0001) and triple-negative (HR = 1.97, P < 0.0001). As the first-line treatment for BM, 186 (14.8%) pts underwent surgery, 291 (23.2%) received stereotactic radiotherapy and 611 (48.6%) underwent whole-brain radiotherapy. Pts treated with surgery and stereotactic radiotherapy showed longer OS (16.3 m) than those treated by whole-brain radiotherapy (7.2 m) (HR = 0.52; P < 0.0001). More than 50% of pts (695/1256) died directly due to BM.

Conclusions

The prognosis and clinical course of pts before and after developing BM vary according to the subtype. Good prognostic factors for OS included the early detection of BM, asymptomatic brain disease, and HER2/ER-positive status. Focusing on the subtypes can optimize the prevention, early detection, and improved treatment of BM.

Disclosure

All authors have declared no conflicts of interest.