A8: Management of brain metastases in patients with advanced HER2 positive and negative breast cancer and their outcomes
1Western General Hospital, Edinburgh, UK
The American Society of Clinical Oncology (ASCO) issued recommendations in July 2014 on the management for patients with HER2 positive advanced breast cancer and brain metastases.
We aim to report on management and outcomes for 138 patients with HER2 positive or negative advanced breast cancer, who were diagnosed with brain metastases during the period 1st January 2009 to 31st December 2013, at the Edinburgh Cancer Centre (ECC).
Retrospective review of 138 patients seen at ECC. Data collected included number and size of brain metastases, prognosis at time of diagnosis of brain metastases, first and subsequent treatments, response to treatment and whether treatment for HER2 positive patients was in accordance with guidelines.
36 patients had HER2 positive breast cancer and 102 HER2 negative breast cancer. Median survival length for HER2 positive breast cancer patients was 458 days compared to 107 days for HER2 negative patients (p<0.0001).
For first line management, 57% of patients (n=79) underwent whole brain radiotherapy. 17% of patients (n=23) underwent craniotomy and excision, of which 48% were HER2 positive. Only 6% of HER2 positive patients were for best supportive care, compared to 31% of HER2 negative patients. There was a significant difference in management of brain metastases between the two groups(p<0.002).
The majority of HER2 positive were treated in accordance with the ASCO guidelines.
Patients with advanced HER2 positive breast cancer and brain metastases have a much better prognosis than HER2 negative patients. Treatments given to such patients for their brain metastases are therefore more interventional which in turn also improves prognosis.
Of the 4 HER2 positive patients whose treatment fell outside the ASCO guidelines, 3 patients were symptomatic with 2 brain metastases. and underwent resection of one or both lesions, all of which were under 3cm. Recommended treatment for such lesions is for stereotactic radiosurgery. There may, therefore, be a role for resection of brain metastases in such cases.