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Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer.

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Noteware, L; Broadwater, G; Dalal, N; Alder, L; Herndon Ii, JE; Floyd, S; Giles, W; Van Swearingen, AED; Anders, CK; Sammons, S
Published in: Breast Cancer Res Treat
January 2023

PURPOSE: Current systemic therapy guidelines for patients with HER2 + breast cancer brain metastases (BCBrM) diverge based on the status of extracranial disease (ECD). An in-depth understanding of the impact of ECD on outcomes in HER2 + BCBrM has never been performed. Our study explores the implications of ECD status on intracranial progression-free survival (iPFS) and overall survival (OS) after first incidence of HER2 + BCBrM and radiation. METHODS: A retrospective analysis was performed of 151 patients diagnosed with initial HER2 + BCBrM who received radiation therapy to the central nervous system (CNS) at Duke between 2008 and 2021. The primary endpoint was iPFS defined as the time from first CNS radiation treatment to intracranial progression or death. OS was defined as the time from first CNS radiation or first metastatic disease to death. Systemic staging scans within 30 days of initial BCBrM defined ECD status as progressive, stable/responding or none (isolated brain relapse). RESULTS: In this cohort, > 70% of patients had controlled ECD with either isolated brain relapse (27%) or stable/responding ECD (44%). OS from initial metastatic disease to death was markedly worse for patients with isolated intracranial relapse (median = 28.4 m) compared to those with progressive or stable/responding ECD (48.8 m and 71.5 m, respectively, p = 0.0028). OS from first CNS radiation to death was significantly worse for patients with progressive ECD (16.9 m) versus stable/responding (36.6 m) or isolated intracranial relapse (28.4 m, p = 0.007). iPFS did not differ statistically based on ECD status. Receipt of systemic therapy after first BCBrM significantly improved iPFS (HR 0.45, 95% CI: 0.25-0.81, p = 0.008) and OS (HR: 0.43 (95% CI: 0.23-0.81); p = 0.001). CONCLUSION: OS in patients with HER2 + isolated BCBrM was inferior to those with concurrent progressive or stable/responding ECD. Studies investigating initiation of brain-penetrable HER2-targeted therapies earlier in the disease course of isolated HER2 + intracranial relapse patients are warranted.

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Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

January 2023

Volume

197

Issue

2

Start / End Page

425 / 434

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Recurrence
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Prognosis
  • Oncology & Carcinogenesis
  • Humans
  • Female
  • Chronic Disease
  • Breast Neoplasms
 

Citation

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Chicago
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MLA
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Noteware, L., Broadwater, G., Dalal, N., Alder, L., Herndon Ii, J. E., Floyd, S., … Sammons, S. (2023). Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer. In Breast Cancer Res Treat (Vol. 197, pp. 425–434). Netherlands. https://doi.org/10.1007/s10549-022-06799-7
Noteware, Laura, Gloria Broadwater, Nicole Dalal, Laura Alder, James E. Herndon Ii, Scott Floyd, William Giles, Amanda E. D. Van Swearingen, Carey K. Anders, and Sarah Sammons. “Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer.” In Breast Cancer Res Treat, 197:425–34, 2023. https://doi.org/10.1007/s10549-022-06799-7.
Noteware L, Broadwater G, Dalal N, Alder L, Herndon Ii JE, Floyd S, et al. Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer. In: Breast Cancer Res Treat. 2023. p. 425–34.
Noteware, Laura, et al. “Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer.Breast Cancer Res Treat, vol. 197, no. 2, 2023, pp. 425–34. Pubmed, doi:10.1007/s10549-022-06799-7.
Noteware L, Broadwater G, Dalal N, Alder L, Herndon Ii JE, Floyd S, Giles W, Van Swearingen AED, Anders CK, Sammons S. Brain metastasis as the first and only metastatic relapse site portends worse survival in patients with advanced HER2 + breast cancer. Breast Cancer Res Treat. 2023. p. 425–434.
Journal cover image

Published In

Breast Cancer Res Treat

DOI

EISSN

1573-7217

Publication Date

January 2023

Volume

197

Issue

2

Start / End Page

425 / 434

Location

Netherlands

Related Subject Headings

  • Retrospective Studies
  • Recurrence
  • Receptor, erbB-2
  • Receptor, ErbB-2
  • Prognosis
  • Oncology & Carcinogenesis
  • Humans
  • Female
  • Chronic Disease
  • Breast Neoplasms