The one year over all survival of breast cancer patients with brain metastasis is only 20%–40%. Approximately, 80% of brain metastases occur after the diagnosis of other systemic metastatic lesions. Due to this dismal prognosis, prophylactic approaches as cranial irradiation, high-dose methotrexate, or lapatinib could be evaluated as preventative measures. However, these approaches are usually toxic and cannot be applied to all patients. This study is carried out to evaluate risk factors that have an impact on subsequent development of brain metastasis in metastatic breast cancer patients and thus, those patients can be candidates for prophylactic measures.
The medical files of 267 metastatic patients were retrospectively reviewed for demographic, clinico pathological, metastatic and treatment characteristics.
46 out of 267 patients developed brain metastasis with an incidence of 17.2%. Significant risks include age 50y (P = 0.031), 24.2% premenopausal patients compared to 11.4% for postmenopausal (P = 0.013), Her2/neu overexpression (48.5%) and triple negative (35.3%) compared to 11.3% patients with ER positive (P = 0.0001, 0.003), high grade compared to low grade tumors (35.6% vs 12.6% P = 0.005). Patients with N2, 3 had higher risk than N0, 1 (44% vs 13.8%) (P = 0.01), 30.9% patients with disease free duration (DFD) 2years (P = 0.019, 0.033). 3.6% patients with bone only metastasis developed brain metastasis compared to 20.6% patients with visceral only metastasis and 27.4% patients with bone and visceral metastasis (P = 0.036, 0.014). 32.3% patients with lung containing metastasis developed brain metastasis compared to 57.3% patients with lung and liver containing metastasis and 9.2% of patients with liver containing metastasis (P = 0.038, 0.022).
Young patients with lung metastases, Her2/neu overexpression or triple negative with disease free duration < 2years carried the highest risk for brain metastases. Such patients may be candidate for screening or prophylactic strategies.
Clinical trial identification
Legal entity responsible for the study
Ethics committee, Faculty of Medicine, Alexandria University.
All authors have declared no conflicts of interest.