TY - JOUR
T1 - Effects of systemic therapy and local therapy on outcomes of 873 breast cancer patients with metastatic breast cancer to brain
T2 - MD Anderson Cancer Center experience
AU - Gao, Chao
AU - Wang, Fuchenchu
AU - Suki, Dima
AU - Strom, Eric
AU - Li, Jing
AU - Sawaya, Raymond
AU - Hsu, Limin
AU - Raghavendra, Akshara
AU - Tripathy, Debu
AU - Ibrahim, Nuhad K.
N1 - Funding Information:
Sheila Wynne Research Fund Funding information
Funding Information:
We thank patients and their families for participating in our study. Sutton Ann M. (Department of Scientific Publications, The University of Texas MD Anderson Cancer Center) provided expert editorial assistance. She did not receive any compensation from a funding sponsor for such contributions. Our study was supported by the Sheila Wynne Research Fund.
Publisher Copyright:
© 2020 Union for International Cancer Control
PY - 2021/2/15
Y1 - 2021/2/15
N2 - Outcomes of treatments for patients with breast cancer brain metastasis (BCBM) remain suboptimal, especially for systemic therapy. To evaluate the effectiveness of systemic and local therapy (surgery [S], stereotactic radiosurgery [SRS] and whole brain radiotherapy [WBRT]) in BCBM patients, we analyzed the data of 873 BCBM patients from 1999 to 2012. The median overall survival (OS) and time to progression in the brain (TTP-b) after diagnosis of brain metastases (BM) were 9.1 and 7.1 months, respectively. WBRT prolonged OS in patients with multiple BM (hazard ratio [HR], 0.68; 95% CI, 0.52-0.88; P =.004). SRS alone, and surgery or SRS followed by WBRT (S/SRS + WBRT), were equivalent in OS and TTP-b (median OS, 14.9 vs 17.2 months; median TTP-b, 8.2 vs 8.6 months). Continued chemotherapy prolonged OS (HR, 0.35; 95% CI, 0.30-0.41; P <.001) and TTP-b (HR, 0.48; 95% CI, 0.33-0.70; P <.001), however, with no advantage of capecitabine over other chemotherapy agents used (median OS, 11.8 vs 12.4 months; median TTP-b, 7.2 vs 7.4 months). Patients receiving trastuzumab at diagnosis of BM, continuation of anti-HER2 therapy increased OS (HR, 0.53; 95% CI, 0.34-0.83; P =.005) and TTP-b (HR, 0.41; 95% CI, 0.23-0.74; P =.003); no additional benefit was seen with switching over between trastuzumab and lapatinib (median OS, 18.4 vs 22.7 months; median TTP-b: 7.4 vs 8.7 months). In conclusion, SRS or S/SRS + WBRT were equivalent for patients' OS and local control. Continuation systemic chemotherapy including anti-HER2 therapy improved OS and TTP-b with no demonstrable advantage of capecitabine and lapatinib over other agents of physicians' choice was observed.
AB - Outcomes of treatments for patients with breast cancer brain metastasis (BCBM) remain suboptimal, especially for systemic therapy. To evaluate the effectiveness of systemic and local therapy (surgery [S], stereotactic radiosurgery [SRS] and whole brain radiotherapy [WBRT]) in BCBM patients, we analyzed the data of 873 BCBM patients from 1999 to 2012. The median overall survival (OS) and time to progression in the brain (TTP-b) after diagnosis of brain metastases (BM) were 9.1 and 7.1 months, respectively. WBRT prolonged OS in patients with multiple BM (hazard ratio [HR], 0.68; 95% CI, 0.52-0.88; P =.004). SRS alone, and surgery or SRS followed by WBRT (S/SRS + WBRT), were equivalent in OS and TTP-b (median OS, 14.9 vs 17.2 months; median TTP-b, 8.2 vs 8.6 months). Continued chemotherapy prolonged OS (HR, 0.35; 95% CI, 0.30-0.41; P <.001) and TTP-b (HR, 0.48; 95% CI, 0.33-0.70; P <.001), however, with no advantage of capecitabine over other chemotherapy agents used (median OS, 11.8 vs 12.4 months; median TTP-b, 7.2 vs 7.4 months). Patients receiving trastuzumab at diagnosis of BM, continuation of anti-HER2 therapy increased OS (HR, 0.53; 95% CI, 0.34-0.83; P =.005) and TTP-b (HR, 0.41; 95% CI, 0.23-0.74; P =.003); no additional benefit was seen with switching over between trastuzumab and lapatinib (median OS, 18.4 vs 22.7 months; median TTP-b: 7.4 vs 8.7 months). In conclusion, SRS or S/SRS + WBRT were equivalent for patients' OS and local control. Continuation systemic chemotherapy including anti-HER2 therapy improved OS and TTP-b with no demonstrable advantage of capecitabine and lapatinib over other agents of physicians' choice was observed.
KW - SRS
KW - brain metastases
KW - breast cancer
KW - overall survival
KW - surgical resection
KW - systemic therapy
KW - time to progression
KW - whole brain radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85090578737&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85090578737&partnerID=8YFLogxK
U2 - 10.1002/ijc.33243
DO - 10.1002/ijc.33243
M3 - Article
C2 - 32748402
AN - SCOPUS:85090578737
SN - 0020-7136
VL - 148
SP - 961
EP - 970
JO - International journal of cancer
JF - International journal of cancer
IS - 4
ER -