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Male Breast Cancer Brain Metastases: Genetic Profiles and Radiosurgery Outcomes
Yusuke S Hori1, Paul M Harary1, Aroosa Zamarud1
1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Background And Objectives:
Male breast cancer (MBC) is very rare, and previous reports of brain metastases (BM) from MBC are limited. To date, the genetic characteristics of MBC with BM have not been explored. In addition, there is only a single case report documenting the use of stereotactic radiosurgery (SRS) for MBC BM. The aim of this study was to summarize genetic alterations associated with BM in patients with MBC and evaluate the safety and efficacy of SRS in this population.
Methods:
Four male patients with a total of 20 MBC BMs treated with SRS were retrospectively reviewed. We defined treatment response as complete response, partial response, stable disease, and local progression (LP), per Response Evaluation Criteria in Solid Tumors (RECIST) criteria. The Kaplan-Meier method was used to estimate cumulative incidence rate of LP.
Results:
The median overall survival was 16.3 months (95% confidence interval: 1.4-31.3 months). The mean age at treatment was 59 years (IQR: 56-60.5 years). Three patients had estrogen receptor-positive lesions, whereas one patient had triple-negative disease. Three patients had notable pathogenic alterations (including in AURKA, BRCA1, BRCA2, CCND1, CHEK2, ERBB2, FLT3, RAF1, and SPINK1). The median lesion size was 5.7 mm (IQR: 3.9-8.6 mm). The median delivered dose was 23 Gy (IQR: 22-24 Gy). Follow-up imaging at 3 months showed a reduction in median lesion size (3.3 mm). The percentage of lesions which were classified as complete response:partial response:stable disease:LP was 0%:45%:55%:0%, respectively. Cumulative 6-month and 12-month local control rates were 100% and 100%, respectively. Only one lesion demonstrated LP at the last follow-up (15 months).
Conclusion:
This is the first report of genetic profiling of MBC with BM and excellent SRS outcomes. The receptor status and genetic alterations across our patients with MBC BM suggest heterogeneity in disease. Larger studies are needed to further explore MBC BM characteristics and treatment outcomes.
Insights
This study explored genetic alterations in male breast cancer (MBC) with brain metastases (BM) and found stereotactic radiosurgery (SRS) to be safe and effective. Genetic profiling revealed disease heterogeneity, suggesting potential for personalized treatment strategies in MBC BM.
Area of Science:
- Oncology
- Genetics
- Neurosurgery
Background:
- Male breast cancer (MBC) with brain metastases (BM) is rare, with limited data on its genetic characteristics.
- Previous reports on stereotactic radiosurgery (SRS) for MBC BM are scarce, with only one case documented.
Purpose of the Study:
- To investigate the genetic alterations associated with BM in male breast cancer patients.
- To evaluate the safety and efficacy of SRS in treating MBC BM.
Main Methods:
- Retrospective review of four male patients with 20 MBC BMs treated with SRS.
- Response evaluation using RECIST criteria and local progression (LP) assessment.
- Kaplan-Meier method for estimating LP incidence rate.
Main Results:
- Median overall survival was 16.3 months.
- Three patients had estrogen receptor-positive disease, one had triple-negative disease.
- Notable pathogenic alterations identified in AURKA, BRCA1, BRCA2, CCND1, CHEK2, ERBB2, FLT3, RAF1, and SPINK1.
- Excellent local control rates at 6 and 12 months (100%) with SRS, with only one lesion progressing.
Conclusions:
- This study presents the first genetic profiling of MBC with BM.
- Genetic alterations and receptor status suggest heterogeneity in MBC BM.
- SRS demonstrates excellent outcomes for MBC BM, warranting further investigation.
