Stefania Gori1, Fabio Puglisi2, Stefano Moroso3, Alessandra Fabi4, Nicla La Verde5, Antonio Frassoldati6, Emiliana Tarenzi7, Ornella Garrone8, Patrizia Vici9, Lucio Laudadio10, Elisabetta Cretella11, Monica Turazza1, Jennifer Foglietta12, Vita Leonardi13, Luigi Cavanna14, Sandro Barni15, Daniele Galanti16, Antonio Russo17, Fabiana Marchetti1, Matteo Valerio1, Gianluigi Lunardi1, Filippo Alongi18, Alessandro Inno19. 1. Unità di Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy. 2. Dipartimento di Medicina (DAME), Università degli studi di Udine, Udine, Italy; Oncologia Medica e Prevenzione Oncologica, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano, Italy. 3. Unità di Oncologia Medica, Azienda Sanitaria Universitaria Integrata Santa Maria Della Misericordia, Udine, Italy. 4. Divisione di Oncologia Medica 1, Istituto Nazionale Tumori Regina Elena, Rome, Italy. 5. Unità di Oncologia Medica, ASST Ospedale Fatebenefratelli Sacco, Milan, Italy. 6. Unità di Oncologia Medica, Azienda Ospedaliero Universitaria Arcispedale Sant'Anna, Ferrara, Italy. 7. Unità di Oncologia Medica, Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milan, Italy. 8. Unità di Oncologia Medica, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo, Italy. 9. Divisione di Oncologia Medica 2, Istituto Nazionale Tumori Regina Elena, Rome, Italy. 10. Unità di Oncologia Medica, Ospedale Floraspe Renzetti, Lanciano, Italy. 11. Unità di Oncologia Medica, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy. 12. Unità di Oncologia Medica, Ospedale di Narni, Narni, Italy. 13. Unità di Oncologia Medica, ARNAS Civico, Palermo, Italy. 14. Dipartimento di Oncologia ed Ematologia, Ospedale Guglielmo da Salicileto, Piacenza, Italy. 15. Unità di Oncologia Medica, ASST Bergamo Ovest, Treviglio, Italy. 16. Unità di Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy; Sezione di Oncologia Medica, Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Università di Palermo, Palermo, Italy. 17. Sezione di Oncologia Medica, Dipartimento di Scienze Chirurgiche, Oncologiche e Stomatologiche, Università di Palermo, Palermo, Italy. 18. Dipartimento di Radioterapia Oncologica Avanzata, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy; Università di Brescia, Brescia, Italy. 19. Unità di Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy. Electronic address: alessandro.inno@sacrocuore.it.
Abstract
BACKGROUND: There is no sufficient evidence to establish a standard of care for patients with brain metastases (BM) from HER2+ breast cancer (BC). The aim of this study was to assess the impact of local and systemic treatments on the outcome of patients diagnosed with BM from HER2+ BC over a period of 10 years, from 2005 to 2014. PATIENTS AND METHODS: Data of 154 patients were retrospectively collected at 14 Italian institutions through a specifically designed database. RESULTS: Median overall survival (OS) was 24.5 months. Patients receiving surgery/stereotactic radiosurgery experienced longer OS compared to those receiving whole-brain radiotherapy or no treatment (33.5 vs. 11.4 months; hazard ratio = 0.34; 95% confidence interval, 0.22-0.52; P < .001). Interestingly, whole-brain radiotherapy did not improve OS compared to no treatment (11.4 vs. 9.8 months; hazard ratio = 0.99; 95% confidence interval, 0.62-1.62; P = .99). HER2-targeted therapy was associated with better OS compared to systemic therapy without HER2-targeted therapy or no systemic therapy (27.5 vs. 5.4 months; hazard ratio = 0.26; 95% confidence interval, 0.17-0.41; P < .001). At multivariate analysis stratified by local treatments, systemic therapy, Karnofsky performance status, and neurologic symptoms significantly affected OS. Age, number of BM, steroid therapy, number of previous lines of systemic therapy, status of extracranial disease, and period of diagnosis had no significant impact on OS. CONCLUSION: Patients with BM from HER2+ BC treated with surgery/stereotactic radiosurgery as local treatment and HER2-targeted therapy as systemic treatment experienced the best outcomes. Patients with low Karnofsky performance status and neurologic symptoms had poor survival.
BACKGROUND: There is no sufficient evidence to establish a standard of care for patients with brain metastases (BM) from HER2+ breast cancer (BC). The aim of this study was to assess the impact of local and systemic treatments on the outcome of patients diagnosed with BM from HER2+ BC over a period of 10 years, from 2005 to 2014. PATIENTS AND METHODS: Data of 154 patients were retrospectively collected at 14 Italian institutions through a specifically designed database. RESULTS: Median overall survival (OS) was 24.5 months. Patients receiving surgery/stereotactic radiosurgery experienced longer OS compared to those receiving whole-brain radiotherapy or no treatment (33.5 vs. 11.4 months; hazard ratio = 0.34; 95% confidence interval, 0.22-0.52; P < .001). Interestingly, whole-brain radiotherapy did not improve OS compared to no treatment (11.4 vs. 9.8 months; hazard ratio = 0.99; 95% confidence interval, 0.62-1.62; P = .99). HER2-targeted therapy was associated with better OS compared to systemic therapy without HER2-targeted therapy or no systemic therapy (27.5 vs. 5.4 months; hazard ratio = 0.26; 95% confidence interval, 0.17-0.41; P < .001). At multivariate analysis stratified by local treatments, systemic therapy, Karnofsky performance status, and neurologic symptoms significantly affected OS. Age, number of BM, steroid therapy, number of previous lines of systemic therapy, status of extracranial disease, and period of diagnosis had no significant impact on OS. CONCLUSION:Patients with BM from HER2+ BC treated with surgery/stereotactic radiosurgery as local treatment and HER2-targeted therapy as systemic treatment experienced the best outcomes. Patients with low Karnofsky performance status and neurologic symptoms had poor survival.
Authors: Anders W Erickson; Farinaz Ghodrati; Steven Habbous; Katarzyna J Jerzak; Arjun Sahgal; Manmeet S Ahluwalia; Sunit Das Journal: Neurooncol Adv Date: 2020-10-14
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Authors: E Laakmann; I Witzel; T Neunhöffer; T-W Park-Simon; R Weide; K Riecke; A Polasik; M Schmidt; J Puppe; C Mundhenke; K Lübbe; T Hesse; M Thill; D-M Zahm; C Denkert; T Fehm; V Nekljudova; J Rey; S Loibl; V Müller Journal: ESMO Open Date: 2022-05-30