Survival benefit of anti-HER2 therapy after whole-brain radiotherapy in HER2-positive breast cancer patients with brain metastasis.
OBJECTIVE
We aimed to assess the survival benefit of epidermal growth factor receptor 2 (HER2)-positive breast cancer patients with brain metastasis (BM) after whole-brain radiotherapy (WBRT) in combination with systemic treatments, especially anti-HER2 therapy.


METHODS
This retrospective study analyzed the overall survival (OS) of 60 HER2-positive breast cancer patients with BM after WBRT in combination with systemic treatments. Among them, 42 patients received chemotherapy while 18 patients did not receive after WBRT. With regard to anti-HER2 therapy, after WBRT, 17 patients received anti-HER2 treatment without prior adjuvant trastuzumab-based therapy, 7 patients received anti-HER2 treatment with prior adjuvant trastuzumab-based therapy, and 36 patients did not receive further anti-HER2 treatment. All patients were followed up regularly until January 23, 2013.


RESULTS
The median OS of patients with BM was 12 months. Patients who received anti-HER2 therapy and chemotherapy after WBRT had significantly better survival compared with patients who did not receive further treatment. Patients who received anti-HER2 treatment after WBRT but did not receive adjuvant trastuzumab-based therapy for early breast cancer had better OS, followed by patients who received anti-HER2 agent both in adjuvant treatment and after WBRT and patients who did not receive anti-HER2 treatment. Multivariate analysis showed that Karnofsky Performance Status, control of extracranial metastases, chemotherapy after WBRT, and anti-HER2 therapy combined with WBRT were all independent predictors for OS.


CONCLUSIONS
Both chemotherapy and anti-HER2 therapy after WBRT could improve OS. Moreover, patients without prior exposure to adjuvant anti-HER2 treatment may have survival benefit superior to those of patients with prior exposure.
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Qian
Q
Zhang
Department of Radiation Oncology, Shanghai Minhang District Cancer Hospital, Shanghai, 200240, China.
Jian
J
Chen
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Xiaoli
X
Yu
Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai, 200032, China.
Gang
G
Cai
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Zhaozhi
Z
Yang
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Lu
L
Cao
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Chaosu
C
Hu
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Xiaomao
X
Guo
Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. sun.jing@zs-hospital.sh.cn.
Jing
J
Sun
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. jiayicchchn@hotmail.com.|Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai, 200032, China. jiayicchchn@hotmail.com.|Department of Radiation Oncology, Rui Jin Hospital, Shanghai Jiaotong University Medical School, 197 Rui Jin 2 Road, Shanghai, 200025, China. jiayicchchn@hotmail.com.
Jiayi
J
Chen
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001921:Brain / Q000528:radiation effects; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000379:methods; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D012189:Retrospective Studies; D016019:Survival Analysis; D000068878:Trastuzumab / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
Brain metastasis; Breast cancer; Human epidermal growth factor receptor 2 (HER2)-positive breast cancer; Survival; Whole-brain radiotherapy