Marcela Carausu1, Matthieu Carton2, Luc Cabel1, Anne Patsouris3, Christelle Levy4, Benjamin Verret5, David Pasquier6, Marc Debled7, Anthony Gonçalves8, Isabelle Desmoulins9, Isabelle Lecouillard10, Thomas Bachelot11, Jean-Marc Ferrero12, Jean-Christophe Eymard13, Marie-Ange Mouret-Reynier14, Michaël Chevrot15, Eleonora De Maio16, Lionel Uwer17, Jean-Sébastien Frenel18, Marianne Leheurteur19, Thierry Petit20, Amélie Darlix21, Laurence Bozec22. 1. Department of Medical Oncology, Institut Curie, Saint-Cloud, France. 2. Department of Biostatistics, Institut Curie, Saint-Cloud, France. 3. Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers, France. 4. Department of Medical Oncology, Centre François Baclesse, Caen, France. 5. Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France. 6. Department of Radiation Oncology, Centre Oscar Lambret, CRIStAL UMR CNRS 9189, Lille University, Lille, France. 7. Department of Medical Oncology, Institut Bergonié, Bordeaux, France. 8. Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France. 9. Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France. 10. Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France. 11. Department of Medical Oncology, Centre Léon Bérard, Lyon, France. 12. Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France. 13. Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, Reims, France. 14. Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France. 15. Unicancer, Paris, France. 16. Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, Toulouse, France. 17. Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France. 18. Department of Medical Oncology, Institut de Cancérologie de l'Ouest-René Gauducheau, Saint-Herblain, France. 19. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France. 20. Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France. 21. Department of Medical Oncology, Institut régional du Cancer de Montpellier (ICM), Institut de Génomique Fonctionnelle, INSERM U1191-CNRS UMR 5203, Université de Montpellier, Montpellier, France. 22. Department of Medical Oncology, Institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France.
Abstract
BACKGROUND: As a result of progress in diagnosis and treatment, there is a growing prevalence of metastatic breast cancer (MBC) with isolated CNS metastases. This study describes the largest-to-date real-life cohort of this clinical setting and compares it to other clinical presentations. METHODS: We retrospectively analysed the French Epidemiological Strategy and Medical Economics (ESME) MBC database including patients who initiated treatment for MBC between 2008 and 2016. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Descriptive statistics and multivariate Cox model were used. RESULTS: Of 22,266 patients, 647 (2.9%) and 929 (4.2%) patients had isolated first-site CNS metastases or combined with extra-CNS metastases, with longer OS for the group with isolated CNS metastases (16.9 versus 13.9 months, adjusted HR = 1.69 (95% CI: 1.50-1.91), p < 0.001). Among the 541 (2.4%) patients with isolated CNS metastases and no intrathecal therapy (excluding leptomeningeal metastases), HER2+ cases were preponderant over TN or HR+ /HER2- cases (41.6% versus 26.1% versus 28.5%, respectively, p < 0.01). The treatment strategy consisted of a combination of local treatment and systemic therapy (49.2%), local treatment only (35.5%) or systemic therapy only (11.4%), or symptomatic therapy only (3.9%). Median PFS was 6.1 months (95% CI: 5.7-6.8). Median OS was 20.7 months (95% CI: 17.3-24.3), reaching 37.9 months (95% CI: 25.9-47.6) in the HR+ /HER2+ subgroup. Older age, TN subtype, MBC-free interval of 6-12 months, lower performance status, and WBRT were associated with poorer survival. Patients who received systemic therapy within 3 months from MBC diagnosis had longer OS (24.1 versus 16.1 months, p = 0.031), but this was not significant on multivariate analysis [HR = 1.0 (95% CI: 0.7-1.3), p = 0.806]. CONCLUSIONS: Patients with isolated CNS metastases at MBC diagnosis represent a distinct population for which the role of systemic therapy needs to be further investigated in prospective studies.
BACKGROUND: As a result of progress in diagnosis and treatment, there is a growing prevalence of metastatic breast cancer (MBC) with isolated CNS metastases. This study describes the largest-to-date real-life cohort of this clinical setting and compares it to other clinical presentations. METHODS: We retrospectively analysed the French Epidemiological Strategy and Medical Economics (ESME) MBC database including patients who initiated treatment for MBC between 2008 and 2016. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Descriptive statistics and multivariate Cox model were used. RESULTS: Of 22,266 patients, 647 (2.9%) and 929 (4.2%) patients had isolated first-site CNS metastases or combined with extra-CNS metastases, with longer OS for the group with isolated CNS metastases (16.9 versus 13.9 months, adjusted HR = 1.69 (95% CI: 1.50-1.91), p < 0.001). Among the 541 (2.4%) patients with isolated CNS metastases and no intrathecal therapy (excluding leptomeningeal metastases), HER2+ cases were preponderant over TN or HR+ /HER2- cases (41.6% versus 26.1% versus 28.5%, respectively, p < 0.01). The treatment strategy consisted of a combination of local treatment and systemic therapy (49.2%), local treatment only (35.5%) or systemic therapy only (11.4%), or symptomatic therapy only (3.9%). Median PFS was 6.1 months (95% CI: 5.7-6.8). Median OS was 20.7 months (95% CI: 17.3-24.3), reaching 37.9 months (95% CI: 25.9-47.6) in the HR+ /HER2+ subgroup. Older age, TN subtype, MBC-free interval of 6-12 months, lower performance status, and WBRT were associated with poorer survival. Patients who received systemic therapy within 3 months from MBC diagnosis had longer OS (24.1 versus 16.1 months, p = 0.031), but this was not significant on multivariate analysis [HR = 1.0 (95% CI: 0.7-1.3), p = 0.806]. CONCLUSIONS: Patients with isolated CNS metastases at MBC diagnosis represent a distinct population for which the role of systemic therapy needs to be further investigated in prospective studies.
Authors: L Gerratana; V Fanotto; M Bonotto; S Bolzonello; A M Minisini; G Fasola; F Puglisi Journal: Clin Exp Metastasis Date: 2015-01-29 Impact factor: 5.150
Authors: Adam S Komorowski; Ellen Warner; Helen J MacKay; Arjun Sahgal; Kathleen I Pritchard; Katarzyna J Jerzak Journal: Clin Breast Cancer Date: 2019-07-11 Impact factor: 3.225
Authors: Yi Xiong; Hang Cao; Yueqi Zhang; Zou Pan; Siyuan Dong; Gousiyi Wang; Feiyifan Wang; Xuejun Li Journal: World Neurosurg Date: 2019-05-13 Impact factor: 2.104
Authors: Riccardo Soffietti; Ufuk Abacioglu; Brigitta Baumert; Stephanie E Combs; Sara Kinhult; Johan M Kros; Christine Marosi; Philippe Metellus; Alexander Radbruch; Salvador S Villa Freixa; Michael Brada; Carmine M Carapella; Matthias Preusser; Emilie Le Rhun; Roberta Rudà; Joerg C Tonn; Damien C Weber; Michael Weller Journal: Neuro Oncol Date: 2017-02-01 Impact factor: 12.300
Authors: Anna S Berghoff; Sophie Schur; Lisa M Füreder; Brigitte Gatterbauer; Karin Dieckmann; Georg Widhalm; Johannes Hainfellner; Christoph C Zielinski; Peter Birner; Rupert Bartsch; Matthias Preusser Journal: ESMO Open Date: 2016-03-16
Authors: F Cardoso; S Paluch-Shimon; E Senkus; G Curigliano; M S Aapro; F André; C H Barrios; J Bergh; G S Bhattacharyya; L Biganzoli; F Boyle; M-J Cardoso; L A Carey; J Cortés; N S El Saghir; M Elzayat; A Eniu; L Fallowfield; P A Francis; K Gelmon; J Gligorov; R Haidinger; N Harbeck; X Hu; B Kaufman; R Kaur; B E Kiely; S-B Kim; N U Lin; S A Mertz; S Neciosup; B V Offersen; S Ohno; O Pagani; A Prat; F Penault-Llorca; H S Rugo; G W Sledge; C Thomssen; D A Vorobiof; T Wiseman; B Xu; L Norton; A Costa; E P Winer Journal: Ann Oncol Date: 2020-09-23 Impact factor: 32.976