Brain metastasis (BM) is infrequently reported in patients (pts) with ovarian cancer (OC), with past studies reporting a rate of approximately 1%.1 This study estimated real-world incidence of BM in OC and assessed whether BRCA mutation (BRCAmut) increased risk of BM in OC pts.
This retrospective study included 4515 pts diagnosed with OC between Jan 1, 2011 and Jan 31, 2018 from the Flatiron Health database. This is a longitudinal, demographically and geographically diverse database derived from electronic health record data from over 265 cancer clinics and over 2 million active US cancer pts. A time-to-event analysis was conducted to assess whether pts with a known BRCAmut were more likely to develop BM compared with BRCA wild type (BRCAwt) pts.
Of 4515 OC pts, 473 were BRCAmut, 1679 were BRCAwt, and 2363 had unknown BRCA status. A total of 46 pts (1%) had a diagnosis of BM subsequent to OC diagnosis. Of those with BRCAmut, 3% (14/473) developed BM; the BM rate was 0.6% (10/1679) for BRCAwt. The K-M estimate for the proportion of pts with BM within 5 years of diagnosis was 5.7% in the BRCAmut population compared with 1.4% in BRCAwt. BRCAmut pts had a significantly higher risk of developing BM compared with BRCAwt (HR 4.44 [95% CI 1.97, 10.00], P < 0.0001). A total of 281 OC pts also had a breast cancer (BC) diagnosis (186 developed BC prior to OC, 95 developed BC after OC diagnosis). After excluding these pts from the analysis, the HR for developing BM among BRCAmut pts vs. BRCAwt pts was 3.84 (95% CI 1.60, 9.22), P = 0.001. Multivariate models adjusting for other pt characteristics yielded similar HRs. Among pts who developed BM, median time from OC diagnosis to BM diagnosis was 27 months in BRCAmut pts and 35 months in BRCAwt. Median survival after diagnosis of BM was 7.16 months (95% CI 3.48, 16.49). Overall survival after BM did not differ significantly by BRCA status.
OC pts with BRCAmut seem to have a higher risk of developing BM. Further research is needed to confirm these findings and better understand potential mechanisms and implications for management, given the poor prognosis in pts who develop BM. 1Pectasides et al. The Oncologist 2006;11:252–260.
Clinical trial identification
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Editorial support, funded by Tesaro, Inc. (Waltham, MA, USA) and coordinated by Michael Stillman PhD of Tesaro, Inc., was provided by Dena McWain of Ashfield Healthcare Communications (Middletown, CT, USA).
E. Ratner: Advisory board: Tesaro Inc. M. Bala, M. Louie-Gao, S. Hazard: Employment and stock and other ownership interests in Tesaro Inc. All other authors have declared no conflicts of interest.