Leptomeningeal disease and breast cancer: the importance of tumor subtype

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• 作者：Sausan Abouharb (1)
  Joe Ensor (2)
  Monica Elena Loghin (3)
  Ruth Katz (4)
  Stacy L. Moulder (5)
  Francisco J. Esteva (6)
  Benjamin Smith (7)
  Vicente Valero (5)
  Gabriel N. Hortobagyi (5)
  Amal Melhem-Bertrandt (5)
  
• 关键词：Breast cancer ; Leptomeningeal disease ; Tumor subtype ; Outcome
• 刊名：Breast Cancer Research and Treatment
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：146
• 期：3
• 页码：477-486
• 全文大小：920 KB
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• 作者单位：Sausan Abouharb (1)
  Joe Ensor (2)
  Monica Elena Loghin (3)
  Ruth Katz (4)
  Stacy L. Moulder (5)
  Francisco J. Esteva (6)
  Benjamin Smith (7)
  Vicente Valero (5)
  Gabriel N. Hortobagyi (5)
  Amal Melhem-Bertrandt (5)
  
  1. Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  3. Department of Neurooncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  4. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  5. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1354, Houston, TX, 77030, USA
  6. New York University Langone Medical Center, New York City, NY, USA
  7. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
  
• ISSN：1573-7217

文摘

Breast cancer (BC) is one of the most common tumors to involve the leptomeninges. We aimed to characterize clinical features and outcomes of patients with LMD based on BC subtypes. We retrospectively reviewed records of 233 patients diagnosed with LMD from BC between 1997 and 2012. Survival was estimated by the Kaplan–Meier method and significant differences in survival were determined by Cox proportional hazards or log-rank tests. Of 190 patients with BC subtype available, 67 (35?%) had hormone receptor positive (HR+)/human epidermal growth factor receptor 2 (HER2)-negative BC, 56 (29?%) had HER2+BC, and 67 (35?%) had triple-negative BC (TNBC). Median age at LMD diagnosis was 50?years. Median overall survival (OS) from LMD diagnosis was 4.4?months for HER2+BC (95?% CI 2.8, 6.9), 3.7?months (95?% CI 2.4, 6.0) for HR+/HER2?BC, and 2.2?months (95?% CI 1.5, 3.0) for TNBC (p?=?0.0002). Older age was associated with worse outcome (p?HER2+BC and LMD were more likely to receive systemic therapy (ST) (p?=?0.001). Use of intrathecal therapy (IT) (52?%) was similar (p?=?0.35). Both IT (p?p?HER2+BC had better OS compared with HR+/HER2?BC (HR 1.72; 95?%CI 1.07-.76) and TNBC (HR 3.30; 95?%CI 1.98-.52). LMD carries a dismal prognosis. Modest survival differences by tumor subtype were seen. Patients with HER2+BC had the best outcome. There is an urgent need to develop effective treatment strategies.