Development of central nervous system metastases as a first site of metastatic disease in breast cancer patients treated in the neoadjuvant trials GeparQuinto and GeparSixto

Journal article


Publication Details

Author(s): Laakmann E, Witzel I, Fasching P, Rezai M, Schem C, Solbach C, Tesch H, Klare P, Schneeweiss A, Salat C, Zahm DM, Blohmer JU, Ingold-Heppner B, Huober J, Hanusch C, Jackisch C, Reinisch M, Untch M, Von Minckwitz G, Nekljudova V, Mueller V, Loibl S
Journal: Breast Cancer Research
Publication year: 2019
Volume: 21
Journal issue: 1
ISSN: 1465-542X


Abstract

Background: The incidence of central nervous system (CNS) metastases in breast cancer patients is rising and has become a major clinical challenge. Only few data are published concerning risk factors for the development of CNS metastases as a first site of metastatic disease in breast cancer patients. Moreover, the incidence of CNS metastases after modern neoadjuvant treatment is not clear. Methods: We analyzed clinical factors associated with the occurrence of CNS metastases as the first site of metastatic disease in breast cancer patients after neoadjuvant treatment in the trials GeparQuinto and GeparSixto (n = 3160) where patients received targeted treatment in addition to taxane and anthracycline-based chemotherapy. Results: After a median follow-up of 61 months, 108 (3%) of a total of 3160 patients developed CNS metastases as the first site of recurrence and 411 (13%) patients had metastatic disease outside the CNS. Thirty-six patients (1%) developed both CNS metastases and other distant metastases as the first site of metastatic disease. Regarding subtypes of the primary tumor, 1% of luminal A-like (11/954), 2% of luminal B-like (7/381), 4% of HER2-positive (34/809), and 6% of triple-negative patients (56/1008) developed CNS metastases as the first site of metastatic disease. In multivariate analysis, risk factors for the development of CNS metastases were larger tumor size (cT3-4; HR 1.63, 95% CI 1.08-2.46, p = 0.021), node-positive disease (HR 2.57, 95% CI 1.64-4.04, p < 0.001), no pCR after neoadjuvant chemotherapy (HR 2.29, 95% CI 1.32-3.97, p = 0.003), and HER2-positive (HR 3.80, 95% CI 1.89-7.64, p < 0.001) or triple-negative subtype (HR 6.38, 95% CI 3.28-12.44, p < 0.001). Conclusions: Especially patients with HER2-positive and triple-negative tumors are at risk of developing CNS metastases despite effective systemic treatment. A better understanding of the underlying mechanisms is required in order to develop potential preventive strategies.


FAU Authors / FAU Editors

Fasching, Peter PD Dr.
Professur für Translationale Frauenheilkunde und Geburtshilfe


External institutions with authors

Centrum für Hämatologie und Onkologie Bethanien
Charité - Universitätsmedizin Berlin
GBG Forschungs GmbH (German Breast Group)
HELIOS Kliniken
Kliniken Essen-Mitte
Rotkreuzklinikum München
Sana Klinikum Offenbach
SRH Wald-Klinikum Gera
Universitätsklinikum Frankfurt
Universitätsklinikum Hamburg-Eppendorf (UKE)
Universitätsklinikum Heidelberg
Universitätsklinikum Schleswig-Holstein (UKSH)
Universität Ulm


How to cite

APA:
Laakmann, E., Witzel, I., Fasching, P., Rezai, M., Schem, C., Solbach, C.,... Loibl, S. (2019). Development of central nervous system metastases as a first site of metastatic disease in breast cancer patients treated in the neoadjuvant trials GeparQuinto and GeparSixto. Breast Cancer Research, 21(1). https://dx.doi.org/10.1186/s13058-019-1144-x

MLA:
Laakmann, Elena, et al. "Development of central nervous system metastases as a first site of metastatic disease in breast cancer patients treated in the neoadjuvant trials GeparQuinto and GeparSixto." Breast Cancer Research 21.1 (2019).

BibTeX: 

Last updated on 2019-07-06 at 09:53