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Local and systemic therapy in breast cancer patients with central nervous system metastases

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

As survival of patients with central nervous system (CNS) metastases from breast cancer is poor and incidence rates are increasing, there is a growing need for better treatment strategies. In the current study, the efficacy of local and systemic therapies was analyzed in breast cancer patients with CNS metastases.

Methods

Medical records from breast cancer patients with brain and/or leptomeningeal metastases (LM) treated at a tertiary referral center and a teaching hospital between 2010 and 2020 were retrospectively studied. Main outcomes of interest were overall survival (OS) and CNS progression free survival. Analyses were performed among patients with brain metastases (BM) and patients with LM, for the different systemic and local therapies for CNS metastases, and for subgroups based on breast cancer subtypes.

Results

We identified 155 patients, 97 with BM and 58 with LM. Median OS was 15.9 months for patients with BM and 1.5 months for patients with LM. Median OS was significantly longer for HER2-positive patients with BM (22.8 months) vs triple negative (8.4 months) and hormone receptor positive/HER2-negative (5.9 months) (P < 0.001). Patients with BM receiving both local and systemic therapy also had a longer median OS (21.8 months), compared to the other three subgroups (local therapy only: 9.9 months, systemic therapy only: 4.3 months, no therapy: 0.5 months, P < 0.001). No significant difference in OS was observed between different systemic treatment regimens.

Conclusion

Breast cancer patients with BM show longest median OS when the subtype is HER2-positive and when they are treated with both local and systemic therapy.

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Data availability

The datasets generated and analyzed during the current study are available via the corresponding author on reasonable request.

Abbreviations

BBB:

Blood–brain barrier

BC:

Breast cancer

BCBM:

Breast cancer brain metastases

BM:

Brain metastases

CI:

Confidence interval

CNS:

Central Nervous System

CSF:

Cerebrospinal fluid

HER2:

Human epidermal growth factor receptor 2

HR:

Hormone receptor

IQR:

Interquartile range

LM:

Leptomeningeal metastases

MRI:

Magnetic resonance imaging

NKI-AvL:

Netherlands Cancer Institute—Antoni van Leeuwenhoek

OS:

Overall survival

PFS:

Progression-free survival

RT:

Radiotherapy

SD:

Standard deviation

SRS:

Stereotactic radiosurgery

TN:

Triple negative

WBRT:

Whole brain radiotherapy

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Authors and Affiliations

  1. Department of Neuro-Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Ninke E. A. Wellerdieck, Peter Wessels & Dieta Brandsma

  2. Department of Neurology, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands

    Ninke E. A. Wellerdieck & Peter Wessels

  3. Department of Internal Medicine, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands

    Maartje Los

  4. Department of Medical Oncology, Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands

    Gabe S. Sonke

  5. Department of Clinical Epidemiology, St Antonius Hospital, Utrecht, The Netherlands

    Ellen Tromp

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  1. Ninke E. A. Wellerdieck
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Correspondence to Dieta Brandsma.

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GSS reports institutional research support from AstraZeneca, Merck, Novartis, Roche and Seagen and advisory roles for Biovica and Seagen. The other authors declare that they have no competing interests.

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Wellerdieck, N.E.A., Wessels, P., Los, M. et al. Local and systemic therapy in breast cancer patients with central nervous system metastases. Breast Cancer Res Treat 194, 365–384 (2022). https://doi.org/10.1007/s10549-022-06605-4

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