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Brain metastasis in gastroesophageal adenocarcinoma and HER2 status

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Abstract

The increased survival of patients with gastroesophageal adenocarcinoma (GAD) following improvements in treatment has been accompanied by a rising incidence of secondary brain metastasis. HER2 amplification/overexpression, which has been associated with an increased risk of brain metastasis in breast cancer, is found in about 20% of patients with GAD. The aim of this study was to evaluate the effect of HER2 status on brain metastasis in GAD. The database of a tertiary cancer center was searched for patients with GAD diagnosed in 2011–2015, and data were collected on clinical characteristics, brain metastasis, HER2 status, and outcome. We identified 404 patients with a confirmed diagnosis of GAD. HER2 results were available for 298: 69 (23.2%) positive and 227 negative. Brain metastasis developed in 15 patients with GAD (3.7%); HER2 results, available in 13, were positive in 6, negative in 6, and equivocal in 1. The brain metastasis rate was significantly higher in HER2-positive than HER2-negative patients with GAD (6/69, 8.7% vs. 6/227, 2.6%; RR = 3.3, 95% CI 1.1–9.9, p = 0.034). Median overall survival from diagnosis of brain metastasis was 2.3 months, with no significant difference by HER2 status. HER2 positive GAD patients may be at increased risk to develop BM. Clinicians should maintain a lower threshold for performing brain imaging in patients with HER2-positive GAD given their increased risk of brain metastasis. The role of anti-HER2 agents in the development and treatment of brain metastasis in GAD warrants further study.

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Author notes

  1. Dror Limon and Omer Gal have contributed equally to this work.

Authors and Affiliations

  1. Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, 4941492, Petach Tikva, Israel

    Dror Limon, Omer Gal, Noa Gordon, Gali Perl, Ofer Purim, Limor Amit, Salomon M. Stemmer, Yulia Kundel, Irit Ben-Aharon, Baruch Brenner & Tali Siegal

  2. Neuro-Oncology Center, Davidoff Center, Rabin Medical Center, Beilinson Hospital, 4941492, Petach Tikva, Israel

    Tali Siegal & Shlomit Yust-Katz

  3. Sackler Faculty of Medicine, Tel-Aviv University, 69978, Tel-Aviv, Israel

    Salomon M. Stemmer, Irit Ben-Aharon, Baruch Brenner & Shlomit Yust-Katz

  4. Department of Gastroenterology, Sheba Medical Center, 52621, Ramat-Gan, Israel

    Lior Katz

Authors
  1. Dror Limon
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  2. Omer Gal
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  3. Noa Gordon
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  4. Lior Katz
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  5. Gali Perl
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  6. Ofer Purim
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  7. Limor Amit
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  8. Salomon M. Stemmer
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  9. Yulia Kundel
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  10. Irit Ben-Aharon
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  11. Baruch Brenner
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  12. Tali Siegal
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  13. Shlomit Yust-Katz
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Corresponding author

Correspondence to Dror Limon.

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The authors declare that they have no conflicts of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

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Cite this article

Limon, D., Gal, O., Gordon, N. et al. Brain metastasis in gastroesophageal adenocarcinoma and HER2 status. J Neurooncol 138, 315–320 (2018). https://doi.org/10.1007/s11060-018-2798-4

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  • DOI: https://doi.org/10.1007/s11060-018-2798-4

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