OTHR-10 - Laura Noteware.mp4

Diverse survival outcomes of HER2+ Breast Cancer Brain Metastases (BrCBM) presenting with isolated brain relapse compared to those with concurrent extracranial disease

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Laura Noteware1, Luis Ramirez2, Laura Alder3, Nicole Dalal1, James E. Herndon II2,4, Scott R. Floyd3,5, Amanda E. D. Van Swearingen6, Carey K. Anders3,6, Sarah L. Sammons3,6

1Duke University School of Medicine, Durham, NC, USA. 2Duke Cancer Institute Biostatistics, Durham, NC, USA. 3Duke Cancer Institute, Durham, NC, USA. 4Department of Biostatistics and Bioinformatics, Durham, NC, USA. 5Department of Radiation Oncology, Durham, NC, USA. 6Duke Center for Brain and Spine Metastasis, Durham, NC, USA

Background: In patients with isolated HER2+ BrCBM and no extracranial disease (ECD), there are no consensus guidelines on optimal treatment approaches following CNS-directed therapy. Our goal was to determine the implications of ECD at time of first HER2+ BrCBM on intracranial progression-free survival (PFS1) and overall survival (OS).

Methods: Retrospective analysis was performed on 77 patients with HER2+ BrCBM who received 1st CNS radiation from 2006-2020. Demographics, dates of metastatic and intracranial diagnosis, ECD status at 1st BrCBM, and outcomes were collected. The primary endpoint was PFS1 defined as time from first CNS radiation to the subsequent documentation of intracranial progression (RANO-BM). OS was defined as time from 1st CNS radiation and 1st metastatic disease to date of death/last known alive. ECD status was defined by RECIST1.1 from staging scans within 30 days of 1st BrCBM.

Results: In this patient cohort, 25% (19/77) had isolated brain relapse/no ECD. Median age was 50 years. Most patients (58%) developed first BrCBM during adjuvant or early-line metastatic therapy. All patients with no ECD presented with isolated brain relapse as first metastatic presentation. Patients with concurrent ECD presented with first BrCBM at a median of 16.6m (95% CI: 10.5 to 25.3) after initial metastatic presentation. Median OS from initial metastatic presentation to death was worse for patients with isolated brain relapse (25.3m, 95% CI: 16.8 to 35.3) compared to those with concurrent ECD (49.7m, 95% CI: 43.2 to 62; p=0.01). Median OS from first CNS involvement to death was not statistically different amongst groups.

Conclusions: Patients with isolated HER2+ BrCBM as their initial metastatic event have substantially worse OS compared to patients with concurrent ECD developing CNS metastases later in their disease course. This population with isolated brain relapse deserves investigation of novel treatment algorithms, including earlier introduction of brain-penetrable HER2-targeted agents.

Duration: 05:06

Posted: Monday, August 9, 2021

Video tags: 3rd Annual Conference on Brain Metastases - Pre-Records