This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gori, S. Articles by Crinò, L. Search for Related Content PubMed PubMed Citation Articles by Gori, S. Articles by Crinò, L.

Breast Cancer

Central Nervous System Metastases in HER-2–Positive Metastatic Breast Cancer Patients Treated with Trastuzumab: Incidence, Survival, and Risk Factors

^aMedical Oncology Division, Azienda Ospedaliera Perugia, Perugia, Italy; ^bMedical Oncology Division, Bellaria Hospital, Bologna, Italy; ^cMedical Oncology Service, ASL 2 Perugino, Marsciano, Italy; ^dMedical Oncology, Azienda Ospedaliera Reggio Emilia, Reggio Emilia, Italy; ^eInstitute of Pathological Anatomy and Histology, Division of Cancer Research-Perugia University, Perugia, Italy; ^fRadiotherapy Institute, Perugia University, Policlinico Monteluce, Perugia, Italy

Key Words. CNS metastasis incidence • HER-2–positive breast cancer • Prognosis • Risk factors

Correspondence: Stefania Gori, M.D., Medical Oncology Division, Azienda Ospedaliera Perugia, Via Dottori 1, 06156 Perugia, Italy. Telephone: 39-075-5784212; Fax: 39-075-5279082; e-mail: stefania.gori{at}tin.it

Background. A higher incidence of central nervous system (CNS) metastases in HER-2–positive metastatic breast cancer (MBC) has recently been reported.

Materials and Methods. Aims of this observational study were to evaluate the incidence of CNS metastases in HER-2–positive MBC patients, to define the outcome of patients with CNS metastases, and to identify the risk factors for CNS relapse.

Results. Between April 1999 and June 2005 we treated 122 consecutive HER-2–positive MBC patients with chemotherapy and trastuzumab. At a median follow-up of 28 months from the occurrence of metastatic disease, 43 patients (35.2%) developed CNS metastases. The median time to death from the diagnosis of CNS metastases was 23.46 months. At multivariate analysis we found that only premenopausal status at diagnosis of breast cancer and visceral metastases as the dominant site at relapse were significantly associated with a higher risk for CNS metastases.

Conclusion. The CNS metastasis incidence is very high in HER-2–positive MBC, but the survival after CNS relapse in these patients is longer than in patients unselected for HER-2 status, because of the better control of extracranial disease obtained by trastuzumab. The identified risk factors for CNS relapse could allow us to select a subgroup of HER-2–positive MBC patients as candidates for active surveillance for CNS progression (by computed tomography or magnetic resonance imaging) and/or as candidates for accrual in trials of prevention of CNS relapse.

Disclosure of potential conflicts of interest is found at the end of this article.

This article has been cited by other articles:

				U. Torresi Trastuzumab-treated advanced breast cancer patients and brain metastases: just a little alert Ann. Onc., January 1, 2008; 19(1): 191 - 191. [Full Text] [PDF]

				G. Metro, I. Sperduti, M. Russillo, M. Milella, F. Cognetti, and A. Fabi Clinical Utility of Continuing Trastuzumab Beyond Brain Progression in HER-2 Positive Metastatic Breast Cancer Oncologist, December 1, 2007; 12(12): 1467 - 1469. [Full Text] [PDF]

				S. Gori, V. D. Angelis, M. Colozza, and L. Crino In Reply Oncologist, December 1, 2007; 12(12): 1469 - 1471. [Full Text] [PDF]