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Survival Among Patients With ERBB2-Positive Metastatic Breast Cancer and Central Nervous System Disease.

Emanuela Ferraro¹, Anne S Reiner², Rabih Bou Nassif³

¹Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

JAMA Network Open

|January 31, 2025

Summary

This summary is machine-generated.

Patients with ERBB2-positive metastatic breast cancer (MBC) and brain metastasis have a high risk of death from central nervous system (CNS) causes. Leptomeningeal disease (LMD) and whole-brain radiotherapy are associated with increased CNS-related mortality.

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Area of Science:

Oncology
Neurology
Breast Cancer Research

Background:

Approximately one-third of ERBB2-positive metastatic breast cancer (MBC) patients develop brain metastasis.
Outcomes and causes of death in patients with CNS-limited disease versus those with concomitant extracranial metastasis are not well understood.

Purpose of the Study:

To assess overall survival (OS) and CNS-related mortality in ERBB2+ MBC patients with CNS disease.
To compare outcomes based on disease distribution: CNS-only vs. CNS plus extracranial metastasis.

Main Methods:

Retrospective cohort study of 274 ERBB2+ MBC patients with CNS disease (parenchymal, LMD, or dural metastasis).
Data collected from August 2010 to April 2022 at Memorial Sloan Kettering Cancer Center.
Overall survival estimated using Kaplan-Meier; CNS-related mortality assessed using cumulative incidence.

Main Results:

Median OS varied significantly by presentation: LMD (1.24 years), extracranial metastasis (2.16 years), and CNS-only disease (3.57 years).
55.2% of deaths were CNS-related.
CNS-only disease was associated with a 3-year CNS-related death rate of 33.98%.
LMD and whole-brain radiotherapy were associated with increased CNS-related death.

Conclusions:

Over half of deaths in ERBB2+ MBC patients with brain metastasis are CNS-related, particularly in LMD.
CNS-only presentation offers improved survival but carries a high risk of CNS-related death.
Aggressive local therapy may benefit select patients with CNS-only disease.