Breast cancer patients with brain metastases are a heterogeneous group with respect to tumor biology. The aim of this study is to describe the clinicopathological features and treatment outcomes of breast cancer patients with brain metastases.
Medical records of thirty four breast cancer patients with brain metastases treated at our institute from January 2006 to December 2013 were reviewed. The study population was divided into four biological subgroups depending upon receptor status: Luminal A (ER/PR positive, Her 2 negative); Luminal B (ER/PR positive, Her 2 positive); Her 2 like (ER/PR negative, Her 2 positive) and triple negative (ER/PR negative, Her 2 negative).
The frequency of patients with Luminal A, Luminal B, Her 2 like and triple negative breast cancer with brain metastases were 21%, 29%, 29% and 21% respectively. Fifty percent of Her2 like breast cancer patients, spread to brain as the first site of distant metastases as compared to Luminal A (28%), Luminal B (20%), Triple negative (28%) subtype (p = 0.549). In the entire group, median survival calculated from brain metastases was 8 months and 6, 9, 14 and 5 months in Luminal A; Luminal B; Her 2 like and triple negative subsets, respectively (P = 0.570). Median survival from brain metastases in study population without and with systemic treatment was 3 and 14 months, respectively (p = 0.001). Among Luminal A breast cancer patients, median survival without and with systemic therapy was 3 and 8 months, respectively (p = 0.025). In Luminal B and Her 2 like subsets, median survival with treatment was 16 and 19 months respectively while median survival without treatment was not reached. Median survival in triple negative breast cancer patients without and with chemotherapy was 0 and 5 months, respectively (p = 0.01). Cox multivariate analysis showed that use of systemic treatment after brain metastases increased survival probably due to improved control of systemic disease (p= 0.029).
Patients with Her 2 like phenotype have increase odds of metastasizing to brain as the first site of distant metastases. Systemic treatment after development of brain metastases improves survival in luminal A and triple negative subgroups, likely due to better control of systemic disease.
Clinical trial identification
All authors have declared no conflicts of interest.