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The presentation of brain metastases in melanoma, non-small cell lung cancer, and breast cancer and potential implications for screening brain MRIs

Abstract

Purpose

This study assessed the presentation and institutional outcomes treating brain metastases (BM) of breast cancer (BC), non-small cell lung cancer (NSCLC), and melanoma origin.

Methods

Patients with brain metastases treated between 2014 and 2019 with primary melanoma, NSCLC, and BC were identified. Overall survival (OS) was calculated from dates of initial BM diagnosis using the Kaplan–Meier method.

Results

A total of 959 patients were identified including melanoma (31%), NSCLC (51%), and BC (18%). Patients with BC were younger at BM diagnosis (median age: 57) than NSCLC (65) and melanoma patients (62, p < 0.0001). Breast cancer patients were more likely to present with at least 5 BM (27%) than NSCLC (14%) and melanoma (13%), leptomeningeal disease (23%, 6%, and 6%, p = 0.0004) and receive whole brain radiation therapy (WBRT) (58%, 37%, and 22%, p < 0.0001). There were no differences in surgical resection (24%, 24%, and 29%, p = 0.166). Median OS was shorter for BC patients (9.9, 10.3, and 13.7 months, p = 0.0006).

Conclusion

Breast cancer patients were more likely to be younger, present with advanced disease, require WBRT, and have poorer OS than NSCLC and melanoma patients. Further investigation is needed to determine which BC patients are at sufficient risk for brain MRI screening.

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Data availability

Summary data supporting the results reported in this article can be requested by emailing the corresponding author.

Code availability

Not applicable.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Contributions

KA, TKP, and MM designed the study and prepared the manuscript. MF, YK, TKP, and MM contributed to data collection. KA and MM performed the statistical analysis. KA, NBF, AES, IRW, RD, DEO, HMY, ABE, MAV, BJC, JAA, SS, PAF, HHS, and HSH assisted with data analysis, data interpretation, manuscript editing, and review.

Corresponding author

Correspondence to Kamran A. Ahmed.

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Conflict of interest

Hsiang-Hsuan Michael Yu has received speaker’s honoraria from BrainLab and is on the advisory boards of Novocure and Abbvie. Michael A. Vogelbaum has indirect equity and royalty rights from Infuseon Therapeutics and has received honoraria from Tocagen, Cellinta, and Celgene. Peter A. Forsyth has received research funding from Pfizer and Celgene and is on the advisory boards of Novocure, BTG, Inovio, Abbvie, Ziopharm, Tocagen, and Pfizer. Hatem Soliman serves as a consultant for AstraZeneca, Celgene, Novartis, PUMA, and Eisai. Brian J Czerniecki has intellectual property on a HER2 dendritic cell vaccine. Hyo S. Han declares that she has received a speaker’s honorarium from Lilly Pharmaceuticals, research funding from Abbvie, Arvinas, GSK, Marker therapeutic, Novartis, Bristol-Myers Squibb, Pfizer, SeattleGenetics, Prescient, Horizon, Zymeworks, and Karyopharm. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb, Eli Lilly, and Genentech.

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Mills, M.N., Potluri, T.K., Kawahara, Y. et al. The presentation of brain metastases in melanoma, non-small cell lung cancer, and breast cancer and potential implications for screening brain MRIs. Breast Cancer Res Treat (2021). https://doi.org/10.1007/s10549-021-06420-3

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Keywords

  • Brain metastases
  • Breast
  • Melanoma
  • NSCLC
  • Brain MRI