title: Brain metastases in patients who receive trastuzumab-containing chemotherapy for HER2-overexpressing metastatic breast cancer.
abstract: BACKGROUND
  Recently, a high rate of brain metastases has been reported among patients with human epidermal growth factor receptor (HER2)-overexpressing metastatic breast cancer who were treated with trastuzumab. The present study examined risk factors for the development of brain metastasis in patients with HER2-overexpressing breast cancer who were treated with trastuzumab.
  
  
  METHODS
  We retrospectively reviewed 204 patients with HER-2-overexpressing breast cancer who were treated with a trastuzumab-containing regimen between 1999 and 2006. Patients with clinical symptoms were diagnosed as having brain metastases when brain magnetic resonance imaging (MRI) or a computed tomography (CT) scan revealed positive findings for brain metastases. The median follow-up time of this cohort was 53.6 months.
  
  
  RESULTS
  Among the patients who received a trastuzumab-containing regimen, 74 patients (36.3%) developed brain metastases. The median survival from the diagnosis of brain metastases was 13.5 months (95% confidence interval [CI], 12.2-14.7 months). The median time interval between the beginning of trastuzumab treatment and the diagnosis of brain metastases was 13.6 months (range, 0.0-45.8 months). Among patients with brain metastases, the median overall survival period was 39 months. A multivariate logistic regression analysis showed that age (<or=50 years), recurrent breast cancer, and liver metastases were significant risk factors for the development of brain metastases.
  
  
  CONCLUSIONS
  Patients with HER2-overexpressing breast cancer treated with trastuzumab had a high incidence of brain metastases (36.3%). Routine screening for brain metastases 1 year after the start of trastuzumab treatment, may be warranted in younger patients (</=50 years) who had recurrent breast cancer with liver metastases.
authors.affiliation: Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Ono
authors.forename: Masashi
authors.initials: M
authors.lastname: Ando
authors.forename: Mayu
authors.initials: M
authors.lastname: Yunokawa
authors.forename: Eriko
authors.initials: E
authors.lastname: Nakano
authors.forename: Kan
authors.initials: K
authors.lastname: Yonemori
authors.forename: Koji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kouno
authors.forename: Chikako
authors.initials: C
authors.lastname: Shimizu
authors.forename: Kenji
authors.initials: K
authors.lastname: Tamura
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Katsumata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujiwara
mesh_terms: D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human