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Survival analysis of patients with brain metastases at initial breast cancer diagnosis over the last decade

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Abstract

Purpose

There have been significant advances in the treatment of metastatic breast cancer (BC) over the past years, and long-term outcomes after a diagnosis of brain metastases are lacking. We aimed to identify predictors of brain metastases at initial breast cancer diagnosis, describe overall survival (OS) in the past decade, and identify factors associated with OS after brain metastases diagnosis.

Methods

We evaluated patients with de novo stage IV BC using the Surveillance, Epidemiology and End Results database from 2010 to 2019. Multivariate logistic regression was conducted to assess predictors of brain metastases at initial breast cancer diagnosis. OS was estimated using the Kaplan-Meier method and log rank test was used to compare differences between groups. Cox regression was used to assess associations between several variables and OS.

Results

1,939 patients with brain metastases at initial breast cancer diagnosis were included. Factors associated with this presentation were grade III/IV tumors, ductal histology, hormone receptor (HR)-negative/human epidermal growth factor receptor 2 (HER2)-positive subtype, and extracranial metastases. Patients with HR-positive/HER2-positive disease had the longest OS (median 18 months) and 12.2% were alive at 8 years. Factors associated with shorter OS included older age, lower income, triple-negative subtype, higher grade, and visceral metastases.

Conclusion

Over the last decade, the median OS of patients with brain metastases at initial breast cancer diagnosis remained poor; however, a substantial minority survive 5 or more years, with rates higher in patients with HER2-positive tumors. In addition to tumor subtype, OS varied according to age, extracranial metastases, and sociodemographic factors.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

Susan G. Komen (CCR19609014 to J.P.L.)

Author information

Authors and Affiliations

  1. Department of Medicine, St Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Jorge Avila

  2. Grupo Oncológico Cooperativo Del Sur (GOCS), Neuquén, Argentina

    Julieta Leone & Carlos T. Vallejo

  3. Medical Oncology, Susan F. Smith Center for Women’s Cancer, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA

    Nancy U. Lin & José P. Leone

Authors
  1. Jorge Avila
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  5. José P. Leone
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Contributions

Study concepts: NUL, JPLStudy design: NUL, JPL. Data acquisition: JPL. Quality control of data and algorithms: JL, JPL. Data analysis and Interpretation: JA, JL, JPL. Statistical analysis: JL, JPL. Manuscript preparation: JA, JL, JPL. Manuscript editing: All authors. Manuscript review: All authors.

Corresponding author

Correspondence to Jorge Avila.

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Competing interests

NUL received research funding from Genentech Pfizer, Merck, Seattle Genetics, Zion Pharmaceuticals, Olema Pharmaceuticals, AstraZeneca and UpToDate; and consulting honoraria from Puma, Seattle Genetics, Daichii-Sankyo, AstraZeneca, Denali Therapeutics, Prelude Therapeutics, Olema Pharmaceuticals, Aleta BioPharma, Affinia Therapeutics, Voyager Therapeutics, Janssen, Blueprint Medicines, and Stemline/Menarini. JPL received research funding from Kazia Therapeutics and from Seagen; and consulting honoraria from Minerva Biotechnologies. All other authors have no conflicts.

Conflicts of interest

NUL received research funding from Genentech Pfizer, Merck, Seattle Genetics, Zion Pharmaceuticals, Olema Pharmaceuticals, AstraZeneca and UpToDate; and consulting honoraria from Puma, Seattle Genetics, Daichii-Sankyo, AstraZeneca, Denali Therapeutics, Prelude Therapeutics, Olema Pharmaceuticals, Aleta BioPharma, Affinia Therapeutics, Voyager Therapeutics, Janssen, Blueprint Medicines, and Stemline/Menarini. JPL received research funding from Kazia Therapeutics and from Seagen; and consulting honoraria from Minerva Biotechnologies. All other authors have no conflicts.

Previous presentation

This study was presented in poster format and in a poster discussion session at the 2022 San Antonio Breast Cancer Symposium, which took place from December 6–10 in San Antonio, TX, USA.

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Avila, J., Leone, J., Vallejo, C.T. et al. Survival analysis of patients with brain metastases at initial breast cancer diagnosis over the last decade. Breast Cancer Res Treat (2024). https://doi.org/10.1007/s10549-024-07290-1

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