title: Prognostic factors of HER2-positive breast cancer patients who develop brain metastasis: a multicenter retrospective analysis.
abstract: The clinical course and prognostic factors of HER2-positive breast cancer patients with brain metastases are not well known because of the relatively small population. The aim of this study was to determine prognostic factors associated with HER2-positive patients who develop brain metastases. This retrospective study assessed the largest dataset to date of 432 HER2-positive patients who were diagnosed with brain metastases from 24 institutions of the Japan Clinical Oncology Group, Breast Cancer Study Group. The median age of the 432 patients was 54 years (range, 20-86 years). Of the patients, 162 patients (37.5 %) had ER-positive/HER2-positive (ER+HER2+) breast cancer, and 270 (62.5 %) had ER-negative/HER2-positive (ER-HER2+) breast cancer. The median brain metastasis-free survival period from primary breast cancer was 33.5 months in both groups. The median survival after developing brain metastasis was 16.5 and 11.5 months in the ER+HER2+ and ER-HER2+ groups, respectively, (p = 0.117). Patients with >3 brain metastases had significantly shorter overall survival in both ER+HER2+ (p < 0.001) and ER-HER2+ (p = 0.018) groups. Treatment with trastuzumab before developing brain metastases was not associated with survival duration after developing brain metastases (p = 0.571). However, patients treated with both trastuzumab and lapatinib after developing metastasis had significantly longer survival than patients treated with trastuzumab alone, lapatinib alone, or no HER2-targeting agent (p < 0.001). For HER2-positive patients with brain metastases, regardless of the use of trastuzumab before developing brain metastasis, treatment with both trastuzumab and lapatinib might improve survival.
authors.affiliation: Department of Breast Surgical Oncology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Niikura
authors.forename: Norikazu
authors.initials: N
authors.lastname: Masuda
authors.forename: Seiki
authors.initials: S
authors.lastname: Takashima
authors.forename: Rikiya
authors.initials: R
authors.lastname: Nakamura
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Watanabe
authors.forename: Chizuko
authors.initials: C
authors.lastname: Kanbayashi
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ishida
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hozumi
authors.forename: Michiko
authors.initials: M
authors.lastname: Tsuneizumi
authors.forename: Naoto
authors.initials: N
authors.lastname: Kondo
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Naito
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Honda
authors.forename: Akira
authors.initials: A
authors.lastname: Matsui
authors.forename: Tomomi
authors.initials: T
authors.lastname: Fujisawa
authors.forename: Risa
authors.initials: R
authors.lastname: Oshitanai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yasojima
authors.forename: Hideko
authors.initials: H
authors.lastname: Yamauchi
authors.forename: Shigehira
authors.initials: S
authors.lastname: Saji
authors.forename: Hiroji
authors.initials: H
authors.lastname: Iwata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D000077341:Lapatinib; D008875:Middle Aged; D011379:Prognosis; D011799:Quinazolines / Q000008:administration & dosage; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000235:genetics; D012189:Retrospective Studies; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000077341:Lapatinib; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab