Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases
Abstract The development of brain metastases (BMs) in breast cancer (BC) patients remains a challenging complication. Current clinical practice guidelines recommend local treatment of BMs without changing systemic therapy (CST) in patients with stable extracranial disease. We retrospectively investi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2021-03-01
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| Series: | npj Breast Cancer |
| Online Access: | https://doi.org/10.1038/s41523-021-00235-7 |
| _version_ | 1797641295064203264 |
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| author | Omar Alhalabi Zaid Soomro Ryan Sun Elshad Hasanov Aya Albittar Debu Tripathy Vicente Valero Nuhad K. Ibrahim |
| author_facet | Omar Alhalabi Zaid Soomro Ryan Sun Elshad Hasanov Aya Albittar Debu Tripathy Vicente Valero Nuhad K. Ibrahim |
| author_sort | Omar Alhalabi |
| collection | DOAJ |
| description | Abstract The development of brain metastases (BMs) in breast cancer (BC) patients remains a challenging complication. Current clinical practice guidelines recommend local treatment of BMs without changing systemic therapy (CST) in patients with stable extracranial disease. We retrospectively investigated the impact of CST (when applicable as per treating physician’s discretion) following the diagnosis and management of oligometastatic (1–3) BMs in patients without extracranial metastases on the progression-free survival time (PFS), and overall survival (OS). Hazard ratios (HRs) were calculated using the Cox proportional hazard model. Among the 2645 patients with BC and BMs treated between 2002 and 2015, 74 were included for analysis. 40.5% of patients had HER2 + disease. Median time from diagnosis of BC to BMs was 17.6 months. 54%, 8%, and 38% of BMs were managed by radiation, craniotomy, or combination, respectively. Following the primary management of BMs, we observed that CST occurred in 26 (35.5%) patients, consisting of initiation of therapy in 13.5% and switching of ongoing adjuvant therapy in 22%. Median PFS was 6.6 months among patients who had CST compared to 7.1 months in those who did not (HR = 0.88 [0.52–1.47], p = 0.62). Median OS was 20.1 months among patients who had CST compared to 15.1 months in those who did not (HR = 0.68 [0.40–1.16], p = 0.16). Upon the successful local management of oligometastatic BMs in patients without extracranial disease, we did not find a significant difference in survival between patients who experienced a change in systemic therapy as compared to those who did not. |
| first_indexed | 2024-03-11T13:43:32Z |
| format | Article |
| id | doaj.art-b13d01d1e9f04a52984ccf0fe8205030 |
| institution | Directory Open Access Journal |
| issn | 2374-4677 |
| language | English |
| last_indexed | 2024-03-11T13:43:32Z |
| publishDate | 2021-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Breast Cancer |
| spelling | doaj.art-b13d01d1e9f04a52984ccf0fe82050302023-11-02T11:09:11ZengNature Portfolionpj Breast Cancer2374-46772021-03-01711510.1038/s41523-021-00235-7Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastasesOmar Alhalabi0Zaid Soomro1Ryan Sun2Elshad Hasanov3Aya Albittar4Debu Tripathy5Vicente Valero6Nuhad K. Ibrahim7Division of Cancer Medicine, The University of Texas MD Anderson Cancer CenterDepartments of Neuro-Oncology, The University of Texas MD Anderson Cancer CenterBiostatistics, The University of Texas MD Anderson Cancer CenterDivision of Cancer Medicine, The University of Texas MD Anderson Cancer CenterInvestigational Therapeutics, The University of Texas MD Anderson Cancer CenterBreast Medical Oncology, The University of Texas MD Anderson Cancer CenterBreast Medical Oncology, The University of Texas MD Anderson Cancer CenterBreast Medical Oncology, The University of Texas MD Anderson Cancer CenterAbstract The development of brain metastases (BMs) in breast cancer (BC) patients remains a challenging complication. Current clinical practice guidelines recommend local treatment of BMs without changing systemic therapy (CST) in patients with stable extracranial disease. We retrospectively investigated the impact of CST (when applicable as per treating physician’s discretion) following the diagnosis and management of oligometastatic (1–3) BMs in patients without extracranial metastases on the progression-free survival time (PFS), and overall survival (OS). Hazard ratios (HRs) were calculated using the Cox proportional hazard model. Among the 2645 patients with BC and BMs treated between 2002 and 2015, 74 were included for analysis. 40.5% of patients had HER2 + disease. Median time from diagnosis of BC to BMs was 17.6 months. 54%, 8%, and 38% of BMs were managed by radiation, craniotomy, or combination, respectively. Following the primary management of BMs, we observed that CST occurred in 26 (35.5%) patients, consisting of initiation of therapy in 13.5% and switching of ongoing adjuvant therapy in 22%. Median PFS was 6.6 months among patients who had CST compared to 7.1 months in those who did not (HR = 0.88 [0.52–1.47], p = 0.62). Median OS was 20.1 months among patients who had CST compared to 15.1 months in those who did not (HR = 0.68 [0.40–1.16], p = 0.16). Upon the successful local management of oligometastatic BMs in patients without extracranial disease, we did not find a significant difference in survival between patients who experienced a change in systemic therapy as compared to those who did not.https://doi.org/10.1038/s41523-021-00235-7 |
| spellingShingle | Omar Alhalabi Zaid Soomro Ryan Sun Elshad Hasanov Aya Albittar Debu Tripathy Vicente Valero Nuhad K. Ibrahim Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases npj Breast Cancer |
| title | Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| title_full | Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| title_fullStr | Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| title_full_unstemmed | Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| title_short | Outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| title_sort | outcomes of changing systemic therapy in patients with relapsed breast cancer and 1 to 3 brain metastases |
| url | https://doi.org/10.1038/s41523-021-00235-7 |
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