Leptomeningeal metastases (LM) in patients with breast cancer (BC) is rare but associated with poor prognosis. Specific factors associated with prognosis of patients with LM have not been characterized in a large patient cohort. We aimed to evaluate prognostic factors in BC patients with LM from the Brain Metastases in Breast Cancer (BMBC) Registry.
Patient’s and tumor’s main features were retrieved from the BMBC. Median overall survival (mOS) was defined as the time from first diagnosis of central nervous system metastases (CNS) to death from any cause. Median progression-free survival (mPFS) was defined as the time from first diagnosis of CNS to progression in CNS, extracranial metastases or death.
A total of 781 patients with LM and BC were included in the analysis (781/3858, prevalence of 20.2%). 354 (45.3%) patients had LM without BM. A mPFS was3.9 months (95%CI 3.4-4.5) and a mOS was 4.9 months (95% 4.3-5.7). Older age (>=60 vs. <60 years, HR 2.07, 95%CI 1.53-2.79) and a worse ECOG performance status (2-4 vs. 0-1 HR 2.03, 95% CI 1.52-2.71) were significantly associated with a higher risk of death in the multivariate analysis. Endocrine treatment (for hormone-receptor-positive BC) was significantly associated with a lower risk of death (HR 0.43 95%CI 0.28-0.65). Also, whole brain radiotherapy was associated with a lower risk of death (HR 0.62 95%CI 0.45-0.87). Furthermore, BC subtype correlated significantly with prognosis in patients with LM. Patients with luminal-like BC and patients with a triple negative BC had a significant higher risk of death than patients with a triple-positive BC (HR 1.55, 95%CI 1.05-2.28 resp. HR 2.47, 95%CI 1.59-3.85). Additional analyses, including a comparison with patients without LM in the BMBC cohort will be presented.
Patients with LM have a short survival. The identified prognostic factors can support the clinicians to identify the group of patients with a better survival who could possibly benefit from a more intense treatment regimen. Financial support for the management of BMBC Registry was provided by an unrestricted research grant from Daiichi Sankyo to GBG.
The authors.
Financial support for the management of BMBC Registry was provided by an unrestricted research grant from Daiichi Sankyo to GBG.
E. Agostinetto: Financial Interests, Institutional, Speaker’s Bureau: Eli Lilly, Sandoz, AstraZeneca; Financial Interests, Institutional, Other, Support to attend medical conferences, Outside present work: Eil Lilly, Roche, Novartis, Genetics, Instituto Gentili, Daiichi Sankyo. F. Schettini: Financial Interests, Institutional, Other, Travel Support: Novartis, Gilead; Financial Interests, Institutional, Speaker’s Bureau: Novartis; Financial Interests, Institutional, Other, Consulting Fees: Daiichi Sankyo, Gilead. M. Vaz Batista: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker: Daiichi Sankyo; Financial Interests, Personal, Other, Medical Monitor in a Clinical Trial: MedSir. M. Schmidt: Financial Interests, Personal, Other: AstraZeneca, BioNTech, Daiichi Sankyo, Eisai, Lilly, MSD, Novartis, Pantarhei Bioscience, Pfizer, Pierre Fabre, Roche, Seagen; Financial Interests, Institutional, Research Grant: AstraZeneca, BioNTech, Eisai, Genentech, GBG, Novartis, Palleos, Pantarhei bioscience, Pierre Fabre, Seagen; Other, Institutional, Other, EP 2390370 B1: Patent; Other, Institutional, Other, EP 2951317 B1 issued: Patent. C. Denkert: Financial Interests, Personal, Advisory Board: MSD Oncology, Daiichi Sankyo, Molecular Health, AstraZeneca, Roche, Lilly; Financial Interests, Personal, Invited Speaker: AstraZeneca, VmScope digital pathology software; Financial Interests, Institutional, Research Grant: Roche, Myriad, German Breast Group. I. Witzel: Financial Interests, Institutional, Speaker’s Bureau: Seagen, Daiichi Sankyo, AstraZeneca, Lilly, Novartis, Gilead, Roche, MSD; Financial Interests, Institutional, Other, Travel Support: Roche, Pfizer. J. Rey: Financial Interests, Institutional, Full or part-time Employment: GBG; Financial Interests, Institutional, Research Grant: AbbVie, AstraZeneca, BMS, Daiichi Sankyo, Gilead, Novartis, Pfizer, Roche; Financial Interests, Institutional, Writing Engagements: Daiichi Sankyo, Gilead, Novartis, Pfizer, Roche, Seagen; Other, Institutional, Other, EP14153692.0: Patent; Other, Institutional, Other, EP21152186.9: Patent; Other, Institutional, Other, EP15702464.7: Patent; Other, Institutional, Other, EP19808852.8: Patent; Other, Institutional, Royalties: VM Scope GmbH. S. Loibl: Financial Interests, Institutional, Advisory Board, Member: Amgen, AstraZeneca, BMS, Celgene, EirGenix, GSK, Lilly, Pierre Fabre, Roche, Seagen, AbbVie, Sanofi, Gilead, Merck, Novartis, Relay Therapeutics; Financial Interests, Institutional, Invited Speaker: AstraZeneca, DSI, Novartis, Pfizer, Roche, Gilead, Seagen; Financial Interests, Institutional, Advisory Board: DSI, Pfizer, Olema; Financial Interests, Personal, Invited Speaker: Medscape; Financial Interests, Personal, Full or part-time Employment, CEO: GBG Forschungs GmbH; Financial Interests, Institutional, Invited Speaker, Ki67: VM Scope GmbH; Financial Interests, Institutional, Research Grant: AstraZeneca, Celgene, Novartis, Immunomedics/Gilead, Pfizer, Roche, Daiichi Sankyo; Financial Interests, Institutional, Funding: AbbVie, Molecular Health; Financial Interests, Personal, Other, PIPenelope/Padma: Pfizer; Financial Interests, Personal, Other, SC PALOMA3: Pfizer; Financial Interests, Personal, Other, SC SOLAR1: Novartis; Financial Interests, Personal, Other, SC ASCENT: Immunomedics/Gilead; Financial Interests, Personal, Other, SC HERCLIMB: Seagen; Financial Interests, Personal, Other, SC Katherine: Roche; Financial Interests, Personal, Other, SC Capitello; EC Cambria 1: AstraZeneca; Financial Interests, Personal, Other, SC Inavo: Roche; Financial Interests, Personal, Other, SC Destiny B05; SC Destiny B09: Daiichi Sankyo; Non-Financial Interests, Principal Investigator, After publication of primary endpoint: PI Aphinity; Non-Financial Interests, Advisory Role, Group in Germany responsible for breast cancer guidelines: AGO Kommission Mamma; Non-Financial Interests, Member, German Gynaecological Oncology society: AGO; Non-Financial Interests, Member, German Cancer Society: DKG; Non-Financial Interests, Member: ASCO; Non-Financial Interests, Member, Member guideline committee; past chair in ESMO Breast: ESMO; Other, EP14153692.0No financial interest, Institutional: Patent; Other, EP21152186.9No financial interest, institutional: Patent; Other, EP15702464.7No financial interest, institutional: Patent; Other, EP19808852.8 No financial interest, Institutional: Patent. V. Mueller: Financial Interests, Institutional, Speaker’s Bureau: Amgen, AstraZeneca, Daiichi Sankyo, Eisai, GSK, Pfizer, MSD, Medac, Novartis, Roche, Teva, Seagen, Onkowissen, high5 Oncology, Medscape, Gilead, Pierre Fabre, Medscape; Financial Interests, Institutional, Other, Consulting Honoraria: Hexal, Roche, Pierre Fabre, Amgen, ClinSol, Novartis, MSD, Daiichi Sankyo, Eisai, Lilly, Sanofi, Seagen, Gilead, Pierre Fabre; Financial Interests, Institutional, Other, Travel Support: Roche, Pfizer, Daiichi Sankyo, Gilead. All other authors have declared no conflicts of interest.