Relationship between HER2 status and prognosis in women with brain metastases from breast cancer.
OBJECTIVE
To analyze factors affecting outcomes in breast cancer patients with brain metastases (BM) and characterize the role of HER2 status.


METHODS
We identified 264 breast cancer patients treated between 1999 and 2008 for BM. HER2 status was known definitively for 172 patients and was used to define cohorts in which survival and risk factors were analyzed.


RESULTS
Kaplan-Meier survival analysis demonstrated improved mean overall survival (105.7 vs. 74.3 months, p < 0.02), survival after diagnosis of BM (neurologic survival, NS) (32.2 vs. 18.9 months, p < 0.01), and survival after treatment with stereotactic radiosurgery (RS) (31.3 vs. 14.1, p < 0.01) in HER2+ patients relative to those with HER2- breast cancer. HER2+ status was an independent, positive prognostic factor for survival on univariate and multivariate hazard analysis (hazard ratio: overall survival = 0.66, 0.18; NS = 0.50, 0.34). Additionally, subgroup analysis suggests that stereotactic radiosurgery may be of particular benefit in patients with HER2+ tumors.


CONCLUSIONS
Overall survival, NS, and RS are improved in patients with HER2+ tumors, relative to those with HER2- lesions, and HER2 amplification is independently associated with increased survival in patients with BM from breast cancer. Our findings suggest that the prognosis of HER2+ patients may be better than that of otherwise similar patients who are HER2- and that stereotactic radiosurgery may be beneficial for some patients with HER2+ lesions.
Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.
Zhiyuan
Z
Xu
Nicholas F
NF
Marko
Sam T
ST
Chao
Lilyana
L
Angelov
Michael A
MA
Vogelbaum
John H
JH
Suh
Gene H
GH
Barnett
Robert J
RJ
Weil
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D001943:Breast Neoplasms; D005260:Female; D006801:Humans; D008875:Middle Aged; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000401:mortality; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
D018719:Erb-b2 Receptor Tyrosine Kinases