Gerald Wallace, Ronak Kundalia, Ethan Vallebuona, Biwei Cao, Youngchul Kim, Peter Forsyth, Aixa Soyano, Inna Smalley, Yolanda Pina
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For those who eventually developed BC-LMD, we used Kaplan–Meier survival curve, log-rank test, univariable, and multivariate Cox proportional hazards regression model to identify factors affecting time from CNS metastasis to BC-LMD and OS. 128 cases of BC-LMD were identified. The proportion of BC-LMD to total BC patients was higher between 2016 and 2020 when compared to 2011–2015. Patients with HR+ or HER2 + BC experienced longer times between CNS metastasis and LMD than patients with triple-negative breast cancer (TNBC). Systemic therapy and whole-brain radiation therapy (WBRT) was associated with prolonged progression to LMD in all patients. Hormone therapy in patients with HR + BC were associated with a delayed BC-CNS metastasis to LMD progression. Lapatinib treatment was associated with a delayed progression to LMD in patients with HER2 + BC. Patients with TNBC-LMD had shorter OS compared to those with HR + and HER2 + BC-LMD. Systemic therapy, intrathecal (IT) therapy, and WBRT was associated with prolonged survival for all patients. Lapatinib and trastuzumab therapy was associated with improved OS in patients with HER2 + BC-LMD. Increasing rates of BC-LMD provide treatment challenges and opportunities for clinical trials. 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引用次数: 0
摘要
5%-8%的乳腺癌(BC)患者会被诊断为乳腺癌相关脑脊髓疾病(BC-LMD)。我们对 2011 年至 2020 年期间在莫菲特癌症中心确诊的 BC-LMD 患者进行了回顾性研究,以确定 BC-LMD 的发病率变化情况、与 BC 中枢神经系统转移发展为 BC-LMD 相关的因素,以及与 BC-LMD 患者 OS 相关的因素。研究人员对患有 BC 和脑/脊柱转移性疾病的患者进行了鉴定。对于最终发展为BC-LMD的患者,我们采用卡普兰-梅耶生存曲线、对数秩检验、单变量和多变量考克斯比例危险回归模型来确定影响从中枢神经系统转移到BC-LMD的时间和OS的因素。共发现128例BC-LMD病例。与2011-2015年相比,2016-2020年间BC-LMD占BC患者总数的比例更高。与三阴性乳腺癌(TNBC)患者相比,HR+或HER2 + BC患者从中枢神经系统转移到LMD的时间更长。全身治疗和全脑放疗 (WBRT) 与所有患者的 LMD 进展时间延长有关。HR+BC患者接受激素治疗与BC-CNS转移至LMD的进展延迟有关。拉帕替尼治疗与HER2+BC患者延迟进展至LMD有关。与HR +和HER2 + BC-LMD患者相比,TNBC-LMD患者的OS较短。全身治疗、鞘内治疗和WBRT与所有患者的生存期延长有关。拉帕替尼和曲妥珠单抗疗法可改善HER2 + BC-LMD患者的生存期。BC-LMD发病率的增加为临床试验带来了治疗挑战和机遇。目前急需开展前瞻性试验,测试拉帕替尼和/或类似的酪氨酸激酶抑制剂、IT疗法和联合疗法。
Factors associated with overall survival in breast cancer patients with leptomeningeal disease (LMD): a single institutional retrospective review
Breast cancer-related leptomeningeal disease (BC-LMD) is a dire diagnosis for 5–8% of patients with breast cancer (BC). We conducted a retrospective review of BC-LMD patients diagnosed at Moffitt Cancer Center from 2011 to 2020, to determine the changing incidence of BC-LMD, factors which are associated with the progression of BC CNS metastasis to BC-LMD, and factors which are associated with OS for patients with BC-LMD. Patients with BC and brain/spinal metastatic disease were identified. For those who eventually developed BC-LMD, we used Kaplan–Meier survival curve, log-rank test, univariable, and multivariate Cox proportional hazards regression model to identify factors affecting time from CNS metastasis to BC-LMD and OS. 128 cases of BC-LMD were identified. The proportion of BC-LMD to total BC patients was higher between 2016 and 2020 when compared to 2011–2015. Patients with HR+ or HER2 + BC experienced longer times between CNS metastasis and LMD than patients with triple-negative breast cancer (TNBC). Systemic therapy and whole-brain radiation therapy (WBRT) was associated with prolonged progression to LMD in all patients. Hormone therapy in patients with HR + BC were associated with a delayed BC-CNS metastasis to LMD progression. Lapatinib treatment was associated with a delayed progression to LMD in patients with HER2 + BC. Patients with TNBC-LMD had shorter OS compared to those with HR + and HER2 + BC-LMD. Systemic therapy, intrathecal (IT) therapy, and WBRT was associated with prolonged survival for all patients. Lapatinib and trastuzumab therapy was associated with improved OS in patients with HER2 + BC-LMD. Increasing rates of BC-LMD provide treatment challenges and opportunities for clinical trials. Prospective trials testing lapatinib and/or similar tyrosine kinase inhibitors, IT therapies, and combination treatments are urgently needed.
期刊介绍:
Breast Cancer Research is an international, peer-reviewed online journal, publishing original research, reviews, editorials and reports. Open access research articles of exceptional interest are published in all areas of biology and medicine relevant to breast cancer, including normal mammary gland biology, with special emphasis on the genetic, biochemical, and cellular basis of breast cancer. In addition to basic research, the journal publishes preclinical, translational and clinical studies with a biological basis, including Phase I and Phase II trials.