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Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases

  • Clinical Study
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Abstract

Purpose

We investigated the prognostic ability of tumor subtype for patients with breast cancer brain metastases (BCBM) treated with stereotactic radiation (SRT).

Methods

This is a retrospective review of 181 patients who underwent SRT to 664 BCBM from 2004 to 2019. Patients were stratified by subtype: hormone receptor (HR)-positive, HER2-negative (HR+/HER2−), HR-positive, HER2-positive (HR+/HER2+), HR-negative, HER2-positive (HR−/HER2+), and triple negative (TN). The Kaplan–Meier method was used to calculate overall survival (OS), local control (LC), and distant intracranial control (DIC) from the date of SRT. Multivariate analysis (MVA) was conducted using the Cox proportional hazards model.

Results

Median follow up from SRT was 11.4 months. Of the 181 patients, 47 (26%) were HR+/HER2+, 30 (17%) were HR−/HER2+, 60 (33%) were HR+/HER2−, and 44 (24%) were TN. Of the 664 BCBMs, 534 (80%) received single fraction stereotactic radiosurgery (SRS) with a median dose of 21 Gy (range 12–24 Gy), and 130 (20%) received fractionated stereotactic radiation therapy (FSRT), with a median dose of 25 Gy (range 12.5–35 Gy) delivered in 3 to 5 fractions. One-year LC was 90%. Two-year DIC was 35%, 23%, 27%, and 16% (log rank, p = 0.0003) and 2-year OS was 54%, 47%, 24%, and 12% (log rank, p < 0.0001) for HR+/HER2+, HR−/HER2+, HR+/HER2−, and TN subtypes, respectively. On MVA, the TN subtype predicted for inferior DIC (HR 1.62, 95% CI 1.00–2.60, p = 0.049). The modified breast-Graded Prognostic Assessment (GPA) significantly predicted DIC and OS (both p < 0.001).

Conclusions

Subtype is prognostic for OS and DIC for patients with BCBM treated with SRT.

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Data availability

Summary data supporting the results reported in this article can be requested by emailing the corresponding author.

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Authors and Affiliations

  1. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA

    Matthew N. Mills, Nicholas B. Figura, Daniel E. Oliver, Timothy J. Robinson, Hsiang-Hsuan Michael Yu & Kamran A. Ahmed

  2. University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA

    Chetna Thawani

  3. Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA

    Aixa E. Soyano, Brian J. Czerniecki, Hatem H. Soliman & Hyo S. Han

  4. Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA

    Arnold Etame, James K. Liu, Michael A. Vogelbaum & Peter A. Forsyth

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Contributions

KA and MM designed the study and prepared the manuscript. CT and MM contributed to data collection. KA and MM performed the statistical analysis. KA, MM, NF, DO, HY, and TR contributed to data analysis and interpretation. NF, DO, AS, AE, TR, JL, MV, PF, BC, HS, HH, and HY assisted with data analysis, data interpretation, manuscript editing, and review.

Corresponding author

Correspondence to Kamran A. Ahmed.

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Conflict of interest

Hsiang-Hsuan Michael Yu has received speaker’s honoraria from BrainLab and is on the advisory boards of Novocure and Abbvie. Michael A. Vogelbaum has indirect equity and royalty interests in Infuseon Therapeutics, Inc. and has received honoraria from Tocagen, Inc. and Celgene. Peter A. Forsyth has received research funding from Pfizer and Celgene and is on the advisory boards of Novocure, BTG, Inovio, AbbVie, Ziopharm, Tocagen, and Pfizer. Hatem Soliman serves as a consultant for Astrazeneca, Celgene, Novartis, PUMA, and Eisai. Brian J Czerniecki has intellectual property on a HER2 dendritic cell vaccine. Hyo S. Han declares that she has received a speaker’s honorarium from Lilly Pharmaceuticals, research funding from Abbvie, Arvinas, GSK, Marker therapeutic, Novartis, Bristol-Myers Squibb, Pfizer, SeattleGenetics, Prescient, Horizon, Zymeworks and Karyopharm. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb, Eli Lilly, and Genentech.

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This study was approved by the University of South Florida Institutional Review Board.

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Mills, M.N., Thawani, C., Figura, N.B. et al. Breast cancer subtype predicts clinical outcomes after stereotactic radiation for brain metastases. J Neurooncol 152, 591–601 (2021). https://doi.org/10.1007/s11060-021-03735-5

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