Incidence, pattern and timing of brain metastases among patients with advanced breast cancer treated with trastuzumab

Abstract

(2006) Incidence, pattern and timing of brain metastases among patients with advanced breast cancer treated with trastuzumab, Acta Oncologica, 45:2,[196][197][198][199][200][201]

Risk factors for brain relapse in HER2-positive metastatic breast cancer patients

“…Cumulative 3-year risk of brain relapse of 42% is in the range found in other series of HER2-positive advanced breast cancer patients [11][12][13][14][15][16][17]23]. In this cohort the average annual risk of symptomatic brain relapse for surviving patients during consecutive 7 years of follow-up was 10%, with no apparent plateau.…”

“…The knowledge on the predictive value of steroid receptor status for brain metastases in HER2-positive advanced breast cancer patients is scarce. A recent study including patients administered trastuzumab did not demonstrate any association between ER status and the risk of brain relapse [17]. Pathological tumor grade in general breast cancer population is considered highly predictive for clinical behavior of breast cancer, including the risk of brain relapse [18]; however, the impact of this feature in HER2-positive patients is also not well recognized.…”

“…The small number of patients not administered trastuzumab calls for cautious interpretation of this result, nevertheless resistance of brain lesions to trastuzumab therapy was consistently reported by others. Notably, several studies demonstrated the development of brain metastases despite the response to trastuzumab in extracranial sites, and no prophylactic effect of trastuzumab on brain relapse both in advanced disease and in the adjuvant setting [11][12][13][14][15][16][17]. Brain is the sole site of progression in about 10% of advanced breast cancer patients administered trastuzumab [16].…”

“…Currently HER2-positive breast cancer patients are managed with trastuzumab, a monoclonal antibody against extracellular domain of HER2 receptor. Trastuzumab does not cross through the blood-brain barrier and is ineffective in preventing and treating brain lesions [11][12][13][14][15][16][17]. Recently, Food and Drug Administration (FDA) and European Medicines Agency (EMEA) granted approval to lapatinib, an anti-HER2 small-molecule tyrosine kinase inhibitor, for use in women with advanced HER2-positive breast cancer who have progressed on trastuzumab treatment.…”

Antidepressant use and risk of central nervous system metastasis

“…A study conducted by Vuong et al [196] found males had a higher prevalence of brain metastasis than females (p<0.001), but the frequency of brain metastasis in a study conducted by Pickren et al [131] was not different (8.8% in men and 8.7% in women). Race has not been associated with brain metastasis [131] and was not included as a covariate in the majority of studies [8,9,185,187,[189][190][191][192][193][194][195][197][198][199][200][201][202][203][204]. Breast cancer is the most common source of brain metastasis for women [5].…”