TY  - JOUR
A1  - Laakmann, Elena
A1  - Witzel, Isabell
A1  - Neunhöffer, Tanja
A1  - Weide, Rudolf
A1  - Schmidt, Marcus
A1  - Park-Simon, Tjoung-Won
A1  - Möbus, Volker
A1  - Mundhenke, Christoph
A1  - Polasik, Arkadius
A1  - Lübbe, Kristina
A1  - Hesse, Tobias
A1  - Riecke, Kerstin
A1  - Thill, Marc
A1  - Fasching, Peter Andreas
A1  - Denkert, Carsten
A1  - Fehm, Tanja
A1  - Nekljudova, Valentina
A1  - Rey, Julia
A1  - Loibl, Sibylle
A1  - Müller, Volkmar
T1  - Characteristics and clinical outcome of breast cancer patients with asymptomatic brain metastases
T2  - Cancers
N2  - Simple Summary: The prognosis for patients with breast cancer that has spread to the brain is poor, and survival for these women hasn’t improved over the last few decades. We do not currently test for asymptomatic brain metastases in breast cancer patients, although this does happen in some other types of cancer. In this study we wanted to find out more about breast cancer that has spread to the brain and in particular to see whether there might be any advantage to spotting brain metastases before the development of neurological symptoms. Overall, our results suggest that women could be better off if their brain metastases are diagnosed before they begin to cause symptoms. We now need to carry out a clinical trial to see what happens if we screen high-risk breast cancer patients for brain metastases. This will verify whether doing so could increase survival, symptom control or quality of life.

Abstract: Background: Brain metastases (BM) have become a major challenge in patients with metastatic breast cancer. Methods: The aim of this analysis was to characterize patients with asymptomatic BM (n = 580) in the overall cohort of 2589 patients with BM from our Brain Metastases in Breast Cancer Network Germany (BMBC) registry. Results: Compared to symptomatic patients, asymptomatic patients were slightly younger at diagnosis (median age: 55.5 vs. 57.0 years, p = 0.01), had a better performance status at diagnosis (Karnofsky index 80–100%: 68.4% vs. 57%, p < 0.001), a lower number of BM (>1 BM: 56% vs. 70%, p = 0.027), and a slightly smaller diameter of BM (median: 1.5 vs. 2.2 cm, p < 0.001). Asymptomatic patients were more likely to have extracranial metastases (86.7% vs. 81.5%, p = 0.003) but were less likely to have leptomeningeal metastasis (6.3% vs. 10.9%, p < 0.001). Asymptomatic patients underwent less intensive BM therapy but had a longer median overall survival (statistically significant for a cohort of HER2-positive patients) compared to symptomatic patients (10.4 vs. 6.9 months, p < 0.001). Conclusions: These analyses show a trend that asymptomatic patients have less severe metastatic brain disease and despite less intensive local BM therapy still have a better outcome (statistically significant for a cohort of HER2-positive patients) than patients who present with symptomatic BM, although a lead time bias of the earlier diagnosis cannot be ruled out. Our analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of BM.
KW  - brain metastases
KW  - asymptomatic
KW  - breast cancer
Y1  - 2020
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/56306
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-563060
SN  - 2072-6694
VL  - 12
IS  - 2787
PB  - MDPI
CY  - Basel
ER  -