title: Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer.
abstract: Trastuzumab is an effective treatment for patients with metastatic breast cancer (MBC) that overexpresses HER-2. A high incidence of brain metastases (BM) has been noted in patients receiving trastuzumab. A retrospective chart review was conducted of 100 patients commencing trastuzumab for metastatic breast cancer from July 1999 to December 2002, at the Christie Hospital. Seven patients were excluded; five patients developed central nervous system metastases prior to starting trastuzumab, and inadequate data were available for two. Out of the remaining 93 patients, 23 (25%) have developed BM to date. In all, 46 patients have died, and of these 18 (39%) have been diagnosed with BM prior to death. Of the 23 patients developing BM, 18 (78%) were hormone receptor negative and 18 (78%) had visceral disease. Univariate analysis showed a significant association between the development of cerebral disease and both hormone receptor status and the presence of visceral disease. In conclusion, a high proportion of patients with MBC treated with trastuzumab develop symptomatic cerebral metastases. HER-2-positive breast cancer may have a predilection for the brain, or trastuzumab therapy may change the disease pattern by prolonging survival. New strategies to address this problem require investigation in this group of patients.
authors.affiliation: Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Clayton
authors.forename: S
authors.initials: S
authors.lastname: Danson
authors.forename: S
authors.initials: S
authors.lastname: Jolly
authors.forename: W D J
authors.initials: WD
authors.lastname: Ryder
authors.forename: P A
authors.initials: PA
authors.lastname: Burt
authors.forename: A L
authors.initials: AL
authors.lastname: Stewart
authors.forename: P M
authors.initials: PM
authors.lastname: Wilkinson
authors.forename: R S
authors.initials: RS
authors.lastname: Welch
authors.forename: B
authors.initials: B
authors.lastname: Magee
authors.forename: G
authors.initials: G
authors.lastname: Wilson
authors.forename: A
authors.initials: A
authors.lastname: Howell
authors.forename: A M
authors.initials: AM
authors.lastname: Wardley
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology / Q000556:secondary*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D012189:Retrospective Studies; D012307:Risk Factors; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D000068878:Trastuzumab