Abstract
Background
The development of brain metastases occurs commonly in HER2-positive metastatic breast
cancer and is associated with a poorer prognosis. The advent of HER2-targeted therapy
has improved overall survival, but the benefit in patients with brain metastases is
unclear, as these patients are often excluded from clinical trials. This study aimed
to explore real-world outcomes in patients with brain metastases in HER2-positive
MBC.
Materials & Methods
Data was extracted from the TABITHA registry, which consists of patient data collected
prospectively from 16 Australian sites from 24th February 2015 to 31st October 2021.
Data analysed included characteristics of brain metastases, treatment received and
survival outcomes.
Results
A total of 135 (37%) of 361 patients with HER2-positive MBC were diagnosed with brain
metastases during their clinical course, including 45 (12%) with brain metastases
at time of MBC diagnosis. 61 (45%) had ≥4 brain lesions. The most common local therapy
given was whole brain radiation therapy (WBRT) (36%) followed by multi-modality treatment
with both surgery and radiation therapy (27%). The majority of patients received first-line
HER2-targeted treatment with trastuzumab and pertuzumab followed by second-line trastuzumab
emtansine (T-DM1) but third-line therapy was heterogenous. The median overall survival
in patients who developed brain metastases was significantly shorter than those who
did not develop brain metastases (58.9 vs. 96.1 months, P = .02).
Conclusion
Real-world patients diagnosed with brain metastases in HER2-positive MBC have a relatively
poor prognosis, despite advances in HER2-targeted treatment. As the range of HER2-targeted
treatment expands, it is important to pursue clinical trials that focus on patients
with brain metastases.
Keywords
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Article Info
Publication History
Published online: July 13, 2022
Accepted:
July 8,
2022
Received in revised form:
June 12,
2022
Received:
February 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
