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Open Access Highly Accessed Research article

Brain metastases from breast cancer: prognostic significance of HER-2 overexpression, effect of trastuzumab and cause of death

Romuald Le Scodan12*, Ludivine Jouanneau3, Christophe Massard6, Maya Gutierrez4, Youlia Kirova2, Pascal Cherel5, Julie Gachet4, Alain Labib2 and Emmanuelle Mouret-Fourme3

Author Affiliations

1 Department of Radiation Oncology, Centre Hospitalier Privé Saint Grégoire, Saint Grégoire, France

2 Departments of Radiation Oncology, Institut Curie-Hôpital René Huguenin, Saint Cloud, France

3 Medical Statistics, Institut Curie-Hôpital René Huguenin, Saint Cloud, France

4 Medical Oncology, Institut Curie-Hôpital René Huguenin, Saint Cloud, France

5 Radiology, Institut Curie-Hôpital René Huguenin, Saint Cloud, France

6 Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France

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BMC Cancer 2011, 11:395  doi:10.1186/1471-2407-11-395

Published: 19 September 2011

Abstract

Background

To access the prognostic significance of HER-2 overexpression, the effect of trastuzumab and the cause of death in patients with brain metastases (BM) from breast cancer (BC).

Methods

We analyzed the outcome of 130 patients with BM from BC who received whole-brain radiotherapy (WBRT) (without surgery or radiosurgery) between January 1998 and April 2006. Demographic data, tumor characteristics, and treatments were prospectively recorded. The impact of HER-2 overexpression and trastuzumab-based therapy on overall survival (OS) and the cause of death were evaluated.

Results

The median follow-up for the whole population was 6.25 months (mean: 9.15; range: 0.23-53). The median survival time and 1-year survival rates after BM diagnosis were 7.43 months and 35.8% (95% CI: 28-45.7) respectively. The median survival time for HER-2 negative patients (n = 78), HER-2 positive patients not treated with trastuzumab (n = 20) and HER-2 positive patients treated with trastuzumab (n = 32) were 5.9 months, 5.6 months and 19.53 months, respectively. The 1-year survival rates were 26.1%, 29.2% and 62.6% respectively, (p < 0.004). Among the 18 HER-2 positive patients treated with trastuzumab who died, 11 (61%) apparently succumbed from CNS progression, in the face of stable or responsive non-CNS disease. Trastuzumab-based therapy was associated with a 51% reduction in the risk of death (multiadjusted hazard ratio: 0.49; 95% CI, 0.29-0.83).

Conclusions

In our experience, trastuzumab-based therapy for HER-overexpressing tumors was associated with improved survival in BM BC patients. This subgroup of patients may benefit from innovative approaches, in order to obtain better intra cerebral control.

Keywords:
brain metastases; breast cancer; trastuzumab; whole brain radiation therapy