Abstract 286P
Background
Brain metastases (BMs) are a major clinical issue in patients with Human Epidermal Growth Factor Receptor-2 (HER2) positive breast cancer (BC); remaining often the cause of death despite extra-cerebral disease control with HER2-targeted therapies. Considering long-term neurocognitive effects following whole brain radiotherapy, this real-life study was aimed to identify prognostic risk categories providing an adapted therapeutic strategy.
Methods
All patients treated between January 2009 and December 2020 for a brain metastatic (BMC) HER2-positive BC at ICANS, Centre Paul Strauss and University Hospital of Strasbourg were included. Primary endpoint was overall survival. Cox logistic regression was carried out to identify prognosis survival factors. A prognostic score was defined providing the identification of patient categories with similar risks.
Results
Ninety-four patients with HER-2 positive BMC were studied with a 3.7 year-median follow-up. Median age was 54 years (32-89). Positive tumoral hormone receptor was present in 62% of cases, 29 patients (31%) had exclusively brain metastasis, 41 patients (44%) had ≥ 5 lesions while 24 (26%) had only one. Median OS was 18.4 months (95% CI 12.7-24.0). Variables included in the multivariable analysis were listed in the table. Three different categories (low, intermediate and high risk) were identified, with a respectively 3.2 (95% CI 0.3-6.1), 17.1 (95% CI 11.5-22.7) and 41.9 (95% CI 30.5-53.3) month-median OS (p=0.001). Table: 286P
Multivariable analysis of overall survival factors
| Variables | HR (95% CI) |
| Age < vs ≥ 50 years | 0.42 (0.19 - 0.89) |
| Performans status < vs ≥ 2 | 0.35 (0.17 - 0.70) |
| Number of brain metastasis ≥ 5 vs < 5 | 2.22 (1.20 - 4.12) |
| Concomitant extra-CNS* progression yes vs no | 2.31 (1.09 - 4.93) |
| Number of lines before CNS metastatic diagnosis ≥ 2 vs < 2 | 2.09 (1.00 - 4.35) |
*CNS: central nervous system
Conclusions
Based on retrospective data, a prognostic risk score was identified which could help to choose the best therapeutic strategy. The intermediate and high risks categories strongly support the need for a more efficient treatment. On the other hand, in the low category, the optimal therapeutic management needs to be debated considering the risk of neurological deterioration.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.