Central nervous system failure in Korean breast cancer patients with HER2-enriched subtype: Korean radiation oncology group 16-15 multicenter retrospective study

Kyubo Kim, Kyung Hwan Shin, Jin Ho Kim, Doo Ho Choi, Won Park, Yong Bae Kim, Hyun Ju Kim, Jin Hee Kim, Hyeli Park, Sun Young Lee, Jiyoung Kim, Do Hoon Oh, In Ah Kim

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The purpose of this study was to evaluate the risk of central nervous system (CNS) failure in Korean patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer treated with surgery followed by postoperative radiotherapy (RT). Methods: A total of 749 patients from eight institutions were enrolled in this study. All of them underwent surgery followed by postoperative RT from 2003 to 2011; 246 (32.8%) received neoadjuvant chemotherapy and 649 (81.7%) received adjuvant chemotherapy. Adjuvant trastuzumab was administered to 386 patients (48.6%). Results: The median follow-up duration was 84 (range, 8–171) months. The 7-year disease-free and overall survival rates were 79.0% and 84.2%, respectively. On multivariate analysis, mastectomy, nodal involvement, and presence of lymphatic invasion were correlated with poor overall survival (p = 0.004, 0.022, and 0.011, respectively), whereas T stage and lymphatic invasion were associated with disease-free survival (p = 0.018 and 0.005, respectively). Regarding CNS failures, 30 brain metastases, 2 leptomeningeal metastases, and 8 brain and leptomeningeal metastases were noted. The 7-year CNS relapse-free survival rates in patients receiving and not receiving trastuzumab were 91.2% and 96.9%, respectively (p = 0.005). On multivariate analysis, the administration of adjuvant trastuzumab was the only prognostic factor in predicting a higher CNS failure rate (hazard ratio, 2.260; 95% confidence interval, 1.076–4.746; p = 0.031). Conclusion: Adjuvant trastuzumab was associated with higher CNS failure rate in Korean patients with HER2-enriched breast cancer. Close monitoring and reasonable approaches such as CNS penetrating HER2 blockades combined with the current standard therapy could contribute to improving intracranial tumor control and quality of life in patients with CNS metastasis from HER2-enriched breast cancer.

Original languageEnglish
Pages (from-to)120-130
Number of pages11
JournalJournal of Breast Cancer
Volume22
Issue number1
DOIs
Publication statusPublished - 2019 Mar

Bibliographical note

Publisher Copyright:
© 2019 Korean Breast Cancer Society.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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