Her2 overexpressing breast cancer patients are at a high risk for developing brain metastases. We analysed the group of Her 2 overexpressing patients and studied disease and treatment related characteristics of those with and without brain metastases.
We retrospectively analysed 102 Her 2 overexpressing breast cancer patients who received treatment in our centre from 2013 to 2017, out of which 20 patients (19.6%) were found to have brain metastases. Descriptive data was accumulated from electronic medical records. Survival plot was calculated from Kaplan Meir and compared between groups using Log Rank test.
The median age of our study population was 52 years. The median overall survival(OS)of the Her 2 overexpressing cohort was 24.0 months. The 1year, 2year and 3year OS of the cohort without brain metastases was 95%, 90.6% and 82% respectively. Breast cancer specific median survival of the Her 2 overexpressing cohort after diagnosis of brain metastases was 5.06 months (Range 0.1- 17.64 months). It was observed that post development of brain metastases, 6 out of 20 patients (30%) had a survival beyond 6 months (Range 6.3 to 17.6 months) and 4 out of 20 (20%) had survived beyond 12 months. Two patients had undergone stereotactic radiosurgery and both of them survived beyond 1 year. On univariate analyses it was found that presence of estrogen receptor positivity was associated with a better outcome, which was statistically significant (P = 0.038). We also observed that Breast Specific Graded Prognostic assessment (BS-GPA) score of more than 2.5 had a trend towards better outcome(P = 0.49). Three out of 4 patients, who survived beyond 1 year after development of brain metastases had a BS-GPA score more than 2.5. Age, menopausal status and number of extracranial metastases were not found to have an impact on survival.
Estrogen positivity and BS-GPA score of more than 2.5 are associated with improved survival in patients of Her2 overexpressing breast cancer with brain metastases. This subgroup of patients also benefits with novel approaches like stereotactic radiosurgery for better control of intra cerebral disease.
HCG Manavata Cancer Centre.
Has not received any funding.
All authors have declared no conflicts of interest.