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Survival benefit of anti-HER2 therapy after whole-brain radiotherapy in HER2-positive breast cancer patients with brain metastasis

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Abstract

Aim

We aimed to assess the survival benefit of epidermal growth factor receptor 2 (HER2)-positive breast cancer patients with brain metastasis (BM) after whole-brain radiotherapy (WBRT) in combination with systemic treatments, especially anti-HER2 therapy.

Methods

This retrospective study analyzed the overall survival (OS) of 60 HER2-positive breast cancer patients with BM after WBRT in combination with systemic treatments. Among them, 42 patients received chemotherapy while 18 patients did not receive after WBRT. With regard to anti-HER2 therapy, after WBRT, 17 patients received anti-HER2 treatment without prior adjuvant trastuzumab-based therapy, 7 patients received anti-HER2 treatment with prior adjuvant trastuzumab-based therapy, and 36 patients did not receive further anti-HER2 treatment. All patients were followed up regularly until January 23, 2013.

Results

The median OS of patients with BM was 12 months. Patients who received anti-HER2 therapy and chemotherapy after WBRT had significantly better survival compared with patients who did not receive further treatment. Patients who received anti-HER2 treatment after WBRT but did not receive adjuvant trastuzumab-based therapy for early breast cancer had better OS, followed by patients who received anti-HER2 agent both in adjuvant treatment and after WBRT and patients who did not receive anti-HER2 treatment. Multivariate analysis showed that Karnofsky Performance Status, control of extracranial metastases, chemotherapy after WBRT, and anti-HER2 therapy combined with WBRT were all independent predictors for OS.

Conclusion

Both chemotherapy and anti-HER2 therapy after WBRT could improve OS. Moreover, patients without prior exposure to adjuvant anti-HER2 treatment may have survival benefit superior to those of patients with prior exposure.

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Authors and Affiliations

  1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Qian Zhang & Jing Sun

  2. Department of Radiation Oncology, Shanghai Minhang District Cancer Hospital, Shanghai, 200240, China

    Jian Chen

  3. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Xiaoli Yu, Zhaozhi Yang, Lu Cao, Chaosu Hu, Xiaomao Guo & Jiayi Chen

  4. Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai, 200032, China

    Gang Cai & Jiayi Chen

  5. Department of Radiation Oncology, Rui Jin Hospital, Shanghai Jiaotong University Medical School, 197 Rui Jin 2 Road, Shanghai, 200025, China

    Jiayi Chen

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  1. Qian Zhang
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Correspondence to Jing Sun or Jiayi Chen.

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Zhang, Q., Chen, J., Yu, X. et al. Survival benefit of anti-HER2 therapy after whole-brain radiotherapy in HER2-positive breast cancer patients with brain metastasis. Breast Cancer 23, 732–739 (2016). https://doi.org/10.1007/s12282-015-0631-x

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  • DOI: https://doi.org/10.1007/s12282-015-0631-x

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