Trastuzumab prolongs overall survival in patients with brain metastases from Her2 positive breast cancer |
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Authors: | Rupert Bartsch Andrea Rottenfusser Catharina Wenzel Karin Dieckmann Ursula Pluschnig Gabriela Altorjai Margaretha Rudas Robert M Mader Richard Poetter Christoph C Zielinski Guenther G Steger |
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Institution: | (1) Department of Medicine 1 and Cancer Centre, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria;(2) Department of Radiotherapy, Medical University of Vienna, Vienna, Austria;(3) Department of Pathology, Medical University of Vienna, Vienna, Austria |
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Abstract: | Background: Brain metastases are frequently encountered in Her2 positive advanced breast cancer. It is still not clear, if trastuzumab
treatment should be continued following their diagnosis. In this analysis we evaluated if trastuzumab was able to influence
time to in-brain progression (TTP) and overall survival (OS). For this reason, we compared patients who continued on trastuzumab
with a historical control group.
Patients and Methods: Seventeen Her2 positive patients receiving whole brain radiotherapy for brain metastases and continuing on trastuzumab were
identified. As historical control group, thirty-six patients treated before 2002 were identified from a breast cancer database.
We performed a multivariate analysis (Cox regression) to explore which factors were potentially able to significantly influence
TTP and OS.
Results: Median TTP was 6 months, range 1–33+ months. Median OS was 7 months, range 1–38 months. Seventeen patients received trastuzumab
after WBRT. Factors associated with prolonged TTP were KPS (p = 0.001), and intensified local treatment (p = 0.004). A trend towards longer TTP was observed in patients treated with trastuzumab (p = 0.068). OS was significantly influenced by KPS (p < 0.001), and continued antibody therapy (p = 0.001).
Conclusion: Two parameters were significantly associated with prolonged OS: KPS and trastuzumab. While there was a trend towards prolonged
TTP in patients with trastuzumab treatment after WBRT, this did not reach statistical significance. It appears therefore reasonable
to suggest continuation of antibody therapy in patients with good performance status despite disease spreading to the brain.
Concerning activity of trastuzumab in brain metastases themselves, no final conclusion is possible. |
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Keywords: | Advanced breast cancer Brain metastases Her2 positive disease Trastuzumab Whole brain radiotherapy |
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