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Brain metastases – a common issue in breast cancer

Beyond breast specific—Graded Prognostic Assessment in  patients with brain metastases from breast cancer: treatment impact on  outcome Gaia Griguolo DiSCOG-University of Padova IOV – Istituto Oncologico Veneto I.R.C.C.S. Brain metastases – a common issue in breast cancer.

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Brain metastases – a common issue in breast cancer

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  1. Beyond breast specific—Graded Prognostic Assessment in patients with brain metastases from breast cancer: treatment impact on outcome Gaia Griguolo DiSCOG-Universityof Padova IOV – Istituto Oncologico Veneto I.R.C.C.S.

  2. Brain metastases – a common issue in breast cancer • Breast cancer is one of the commonest causes of brainmetastases • 10–15% of patients diagnosed with metastatic breast cancer will eventually develop brain metastases • Rates are higher in HER2-positive (≈30%) and triple negative breast cancer (≈50%) • Breast cancer brain metastases have been traditionally linked to poor prognosis Median OS from CNS metastasis 6.8 mos Lin NU et al. JCO 2004; Altundag K et al. Cancer 2007

  3. Brain metastases – dissecting the abyss Prognostic scores proposed up to 2008 were created from databases containing patients with brain metastases from many different types of primary tumors Only a minority of these patients had primary breast cancer Nieder C et al, BMC Cancer 2009

  4. It’s not just cancer, it’s BREAST cancer Breast Specific – Graded Prognostic Assessment A retrospective database of patients treatedfor brain metastases at 11 istitutionsradiation oncology departmentsbetween June 1993 and January 2010 Total: 3,940 patients Breast Cancer: 400 patients Sperduto PW et al. Int J RadiatOncolBiolPhys 2010 Sperduto PW et al. Int J RadiatOncolBiolPhys 2011

  5. Breast Specific – Graded Prognostic Assessment Sperduto PW et al JCO 2012

  6. Is thisreallyapplicableto ourevery-day clinics?

  7. Population • Breast cancer patients diagnosed with brain metastases between 1st December 1999 and March 2016 and referred to the IstitutoOncologicoVeneto • Inclusion Criteria: • Histologically proven invasive breast carcinoma • age >18 years at the time of breast cancer diagnosis • intraduralbrain metastasis radiologically confirmed using cerebral CE/CT scan and/or brain MRI • Exclusion Criteria: • Breast cancer bone metastasis extending into the cranium in the absence of intradural brain metastasis • Diagnosis of leptomeningeal carcinomatosisconcomitant to brain metastasis diagnosis and patients with diagnosis of leptomeningeal carcinomatosis alone

  8. Population flowchart 219 patients with breast cancer related intra-cranial lesions 1 patient without available data 218 patients 5 patients with breast cancer bone metastasis extending into the cranium 213 patients 14 patients with leptomeningeal disease alone 199 patients 18 patients with concomitant leptomeningeal disease 181 patients Last follow-up May20, 2016

  9. Patient characteristics at time of BC diagnosis Medianageat BC diagnosis: 51 (24-80)

  10. Patient characteristics at time of BM diagnosis

  11. Prognostic factors for OS after BM diagnosis vs 13.8 mos (Sperduto 2012) Median OS from brain metastasis diagnosis was 7.7 mos (95% CI 5.4–10.0)

  12. Prognostic factors for OS after BM diagnosis

  13. Interaction and multivariate analysis • Patients in the less favorable BS-GPA category (BS-GPA index ≤1) were less likely to receive systemic treatment after brain metastasis diagnosis compared to other BS-GPA categories (44% vs. 71%, p = 0.021) • No significant association was observed between BS-GPA category and local treatment (p = 0.264) • Patients undergoing increased lines of local treatments where more likely to receive systemic therapy (p < 0.001)

  14. Conclusions • BC brain metastasis patients represent an extremely heterogeneous group • Increasing evidence supports individualization of treatment for selected good-prognosis patients • Several prognostic tools have been proposed to aid clinicians in these decisions • We should be cautious when applying these prognostic tools in every-day clinics, as substantial differences in patient characteristics may be present • BS-GPA confirmed its prognostic significance in areal-life cohort of BC patients • Both local and systemic treatment added independent prognostication beyond BS-GPA

  15. The next step…Collaboration Department of Medical Oncology, Montpellier, France Nice Cedex, France Dr. William Jacot Dr. AmélieDarlix Department of Gynaecology, Martin-Luther-Universitaet Halle-Wittenberg, Germany Prof. Christoph Thomssen Dr. Eva Kantelhardt Thankyouforyourattention gaia.griguolo@iov.veneto.it

  16. Time to brain metastases Median time to brain metastasis was 41.4 months (CI 95% 32.5–50.3 months). As expected, breast cancer subtype significantly influenced time from BC diagnosis to brain metastasis occurrence.

  17. It’s not just cancer, it’s BREAST cancer And in breast cancer, tumor biology counts Nieder C et al, BMC Cancer 2009

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