Abstract 240P
Background
Brain metastases (BM) are a common complication of HER2+ breast cancer (BC). As several treatment options are available, adequate prognostic stratification is crucial for optimal management. Validated scores, e.g. the BC-Graded Prognostic Assessment (GPA) and subsequent refinements (modified-GPA, updated-GPA), have been proposed to recapitulate significant prognostic factors; however, none of these includes extracranial disease control. We here evaluate the prognostic value of extracranial disease control in patients with HER2+ BCBM beyond commonly used indexes.
Methods
Patients diagnosed with HER2+ BCBM at Istituto Oncologico Veneto - Padova (2002-2021) were included as exploratory cohort. Patients diagnosed with HER2+ BCBM at Montpellier Cancer Institute (2001-2015) were included as validation cohort. BC-GPA, modified-GPA and updated-GPA were calculated; extracranial disease control at BM diagnosis (no disease/stable disease/response vs progressive disease) was evaluated according to RECIST criteria.
Results
The exploratory cohort included 113 patients with HER2+ BCBM; median OS was 12.2 months. Extracranial disease control (N=65, 58%) was significantly associated with better OS, both at univariate (median OS 17.7 vs 8.7 months, p=0.005) and at multivariate analysis after adjustment for BC-GPA (HR 0.61, 95%CI 0.39-0.94, p=0.025), modified-GPA (HR 0.64, 95%CI 0.42-0.98, p=0.039) and updated-GPA (HR 0.63, 95%CI 0.41-0.98, p=0.040). The prognostic impact of extracranial disease control (N=66, 56.4%) was confirmed in the validation cohort (N=117), both at univariate (median OS 20.2 vs 9.1 months, p<0.001) and at multivariate analysis adjusting for BC-GPA (HR 0.41, 95%CI 0.27-0.61, p<0.001), modified-GPA (HR 0.44, 95%CI 0.29-0.67, p<0.001) and updated-GPA (HR 0.42, 95%CI 0.28-0.63, p<0.001).
Conclusions
Extracranial disease control provides independent prognostic information in HER2+ BC patients with BM beyond commonly used prognostic scores.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
University of Padua – Department of Surgery, Oncology and Gastroenterology: BIRD 2020 (to VG, MVD, GG) and BIRD 2021 (to VG, MVD, GG).
Disclosure
G. Griguolo: Financial Interests, Personal, Invited Speaker: Novartis, Eli Lilly; Other, Other, Travel Support: Novartis, Amgen, Daiichi Sankyo; Other, Other, Trave Support: Pfizer. F. Miglietta: Financial Interests, Personal, Other, Personal fees: Roche. W. Jacot: Financial Interests, Personal and Institutional, Other, Honoraria, Travel expenses and Research Grant/Funding: AstraZeneca; Financial Interests, Personal, Other, Honoraria: BMS, Eisai, MSD, Seagen; Financial Interests, Personal and Institutional, Other, Honoraria and Research Grant/Funding: Daiichi Sankyo; Financial Interests, Personal, Other, Honoraria and Travel expenses: Lilly France, Novartis, Pfizer, Roche; Financial Interests, Personal, Other, Travel expenses: Chugai Pharma, Eisai, Glaxo Smithkline, Pierre Fabre, Sanofi Aventis. V. Guarneri: Financial Interests, Personal, Advisory Board: Roche, EliLilly, Novartis, MSD, Gilead; Financial Interests, Personal, Invited Speaker: EliLilly, Novartis; Financial Interests, Institutional, Invited Speaker: EliLilly, Roche, BMS, Novartis, AstraZeneca, MSD, Synton Biopharmaceuticals, Merck. M.V. Dieci: Financial Interests, Personal, Invited Speaker: Eli Lilly, Pfizer; Financial Interests, Personal, Advisory Board: Novartis, Eli lilly, Seagen, Exact Science; Financial Interests, Personal, Other, Consultancy: Pfizer; Financial Interests, Institutional, Research Grant: Veneto Institute of Oncology IOV-IRCCS, Italian Ministry of health, University of Padova. All other authors have declared no conflicts of interest.