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Improved outcomes for triple negative breast cancer brain metastases patients after stereotactic radiosurgery and new systemic approaches

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Abstract

Purpose

Although ongoing studies are assessing the efficacy of new systemic therapies for patients with triple negative breast cancer (TNBC), the overwhelming majority have excluded patients with brain metastases (BM). Therefore, we aim to characterize systemic therapies and outcomes in a cohort of patients with TNBC and BM managed with stereotactic radiosurgery (SRS) and delineate predictors of increased survival.

Methods

We used our prospective patient registry to evaluate data from 2012 to 2023. We included patients who received SRS for TNBC-BM. A competing risk analysis was conducted to assess local and distant control.

Results

Forty-three patients with 262 tumors were included. The median overall survival (OS) was 16 months (95% CI 13–19 months). Predictors of increased OS after initial SRS include Breast GPA score > 1 (p < 0.001) and use of immunotherapy such as pembrolizumab (p = 0.011). The median time on immunotherapy was 8 months (IQR 4.4, 11.2). The median time to new CNS lesions after the first SRS treatment was 17 months (95% CI 12–22). The cumulative rate for development of new CNS metastases after initial SRS at 6 months, 1 year, and 2 years was 23%, 40%, and 70%, respectively. Thirty patients (70%) underwent multiple SRS treatments, with a median time of 5 months (95% CI 0.59–9.4 months) for the appearance of new CNS metastases after second SRS treatment.

Conclusions

TNBC patients with BM can achieve longer survival than might have been previously anticipated with median survival now surpassing one year. The use of immunotherapy is associated with increased median OS of 23 months.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

Study data were generated by the Perlmutter Cancer Center - Data Hub (PCCDH).

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Neurological Surgery, NYU Langone Health, New York University, New York, NY, USA

    Elad Mashiach, Juan Diego Alzate, Fernando De Nigris Vasconcellos, Brandon Santhumayor, Ying Meng, Zane Schnurman, Cordelia Orillac, David H. Harter, John G. Golfinos & Douglas Kondziolka

  2. Department of Radiation Oncology, NYU Langone Health, New York University, New York, NY, USA

    Bernadine R. Donahue, Kenneth Bernstein & Joshua S. Silverman

  3. Perlmutter Cancer Center, NYU Langone Health, New York University, New York, NY, USA

    Sylvia Adams, Rishitha Bollam, Maryann J. Kwa, Marleen Meyers, Ruth Oratz & Yelena Novik

  4. Department of Medicine, NYU Langone Health, New York University, New York, NY, USA

    Sylvia Adams, Rishitha Bollam, Maryann J. Kwa, Marleen Meyers, Ruth Oratz & Yelena Novik

  5. Maimonides Cancer Center, Maimonides Health, Brooklyn, NY, 11220, USA

    Bernadine R. Donahue

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  1. Elad Mashiach
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EM, JDA, FDNV, BS, YM, and KB. The first draft of the manuscript was written by EM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Elad Mashiach.

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This study was approved by the Institutional Review Board. As a retrospective study with minimal risk, a waiver of authorization and informed consent was approved.

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Mashiach, E., Alzate, J.D., De Nigris Vasconcellos, F. et al. Improved outcomes for triple negative breast cancer brain metastases patients after stereotactic radiosurgery and new systemic approaches. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04651-0

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