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Patterns of treatment and outcomes of patients with brain-only metastatic breast cancer

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Abstract

Background

We characterized the risk factors and survival of metastatic breast cancer (MBC) patients with brain metastases (BrM) as the first and only site of disease in a large, retrospective cohort.

Methods

MBC patients treated for BrM with radiation at a quaternary institution between 2005 and 2019 were identified. MBC patients with BrM but without concurrent extracranial metastases (ECM) or leptomeningeal disease (LMD) were classified as brain-only. Factors associated with brain-only MBC, brain-specific progression free survival (bsPFS) and overall survival (OS) were investigated.

Results

A total of 691 patients with MBC and BrM were analyzed. Among them, 67 patients (9.7%, n = 67/691) presented with brain-only MBC without concurrent ECM/LMD. Within this subgroup, 40 patients (5.8%, n = 40/691) remained free of any ECM or LMD, while 17 patients (2.5%) developed LMD, and 10 patients (1.4%%) developed ECM with a median follow-up of 8 months (IQR 2–35). Patients with brain-only MBC were more likely to have a single BrM [OR 3.41 (1.62–7.19), p = 0.001] and either HER2+ [OR 3.3 (1.13–9.65), p = 0.03] or TNBC [OR 4.09 (1.42–11.74), p = 0.009] subtypes. Patients who presented with brain-only MBC also had significantly longer OS [HR 0.45, (0.22–0.86), p = 0.008] and a trend toward longer bsPFS [HR 0.67 (0.44–1.03), p = 0.05] compared to those with concurrent ECM/LMD.

Conclusion

Patients with brain-only MBC had a longer bsPFS and OS than those with ECM. Patients with HER2+ and TNBC were more likely to have brain-only disease compared to those with HR+/HER2- MBC.

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Data availability

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

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, ON, Canada

    Badr Id Said, Hany Soliman, Sten Myrehaug, Chia-Lin Tseng, Jay Detsky & Arjun Sahgal

  2. Applied Statistician, VM Stats, Toronto, ON, Canada

    Veronika Moravan

  3. Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada

    Ellen Warner & Katarzyna J. Jerzak

  4. Department of Medicine, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Katarzyna J. Jerzak

Authors
  1. Badr Id Said
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  2. Hany Soliman
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  3. Veronika Moravan
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  4. Sten Myrehaug
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  5. Chia-Lin Tseng
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  7. Arjun Sahgal
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  8. Ellen Warner
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  9. Katarzyna J. Jerzak
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by BIS, KJ, HS and VM. The first draft of the manuscript was written by BIS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Katarzyna J. Jerzak.

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Competing interests

CLT (advisor: Sanofi, Elekta MR-linac consortium), AJ (advisor: Gamma Knife Icon, honoraria: Astra Zeneca, BrainLAB, Elekta AB; grant: Elekta, BrainLAB, Varian), KJJ (advisor: Amgen, AzstraZeneca, Apo Biologix, Eli Lily, Esai, Genomic Health, Knight Therapeutics, Merck. Myriad Genetics Inc, Novartis, Purdue Pharma, Pfizer, Roche, Seagen; grant: Aztra Zeneca, Eli Lilly, Seagen), BI, HS, VM, SM, JD, EW (none).

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This study received REB approval prior to study initiation.

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Informed consent was obtained from all individual participants included in the study.

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Id Said, B., Soliman, H., Moravan, V. et al. Patterns of treatment and outcomes of patients with brain-only metastatic breast cancer. J Neurooncol 164, 437–445 (2023). https://doi.org/10.1007/s11060-023-04421-4

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