Screening for brain mets could improve quality of life for some with breast cancer

 

Despite having more extensive metastases at presentation, breast cancer patients had outcomes after brain-directed therapy similar to those of lung cancer patients, results of a retrospective, single-center study show.

The breast cancer patients had larger and more numerous brain metastases compared with the non-small-cell lung cancer (NSCLC) patients, according to study results published in JAMA Oncology.

However, median survival was not statistically different between groups, at 1.45 years for the breast cancer patients and 1.09 years for NSCLC patients (P = .06), wrote Daniel N. Cagney, MD, of Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, and his coauthors.

“This finding suggests that intracranial disease in patients with breast cancer was not more aggressive or resistant to treatment, but rather was diagnosed at a later stage,” noted Dr. Cagney and his colleagues.

They described a retrospective analysis of 349 patients with breast cancer and 659 patients with NSCLC, all treated between 2000 and 2015 at Dana-Farber/Brigham and Women’s Cancer Center.

Median metastasis diameter at presentation was 17 mm for the breast cancer patients, compared with 14 mm for the lung cancer patients (P less than .001). Breast cancer patients were significantly more likely to be symptomatic, have seizures, harbor brainstem involvement, and have leptomeningeal disease at the time of diagnosis, the researchers wrote.

“After initial brain-directed therapy, no significant differences in recurrence or treatment-based intracranial outcomes were found between the two groups,” they noted. However, neurological death was seen in 37.3% of the breast cancer group versus 19.9% of the lung cancer group (P less than .001).

 

Dr. Cagney and his coauthors said they conducted the study to identify the potential value of brain-directed MRI screening in breast cancer, which they said is “important given the impact of neurological compromise on quality of life.”

Brain metastases are common in some subsets of breast cancer patients, yet National Comprehensive Cancer Network guidelines do not recommend brain-directed screening in breast cancer, “a recommendation that is based only on expert consensus given the lack of definitive or prospective studies on this issue,” they wrote.

In light of their findings, the investigators suggest that brain-directed MRI screening is important for breast cancer patients who present with potential for intracranial involvement.

“Early identification of intracranial disease facilitates less invasive or less toxic approaches, such as stereotactic radiosurgery or careful use of promising systemic agents, rather than [whole brain radiation therapy] or neurosurgical resection.” they wrote.

In this study, whole brain radiation therapy was more common in the breast cancer group (59.9% versus 42.9% for the lung cancer group; P less than .001), the investigators noted.

Dr. Cagney and colleagues had no conflicts of interest to report.

SOURCE: Cagney DN et al. JAMA Oncol. 2018 May 17. doi: 10.1001/jamaoncol.2018.0813.

 

Despite having more extensive metastases at presentation, breast cancer patients had outcomes after brain-directed therapy similar to those of lung cancer patients, results of a retrospective, single-center study show.

The breast cancer patients had larger and more numerous brain metastases compared with the non-small-cell lung cancer (NSCLC) patients, according to study results published in JAMA Oncology.

However, median survival was not statistically different between groups, at 1.45 years for the breast cancer patients and 1.09 years for NSCLC patients (P = .06), wrote Daniel N. Cagney, MD, of Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, and his coauthors.

“This finding suggests that intracranial disease in patients with breast cancer was not more aggressive or resistant to treatment, but rather was diagnosed at a later stage,” noted Dr. Cagney and his colleagues.

They described a retrospective analysis of 349 patients with breast cancer and 659 patients with NSCLC, all treated between 2000 and 2015 at Dana-Farber/Brigham and Women’s Cancer Center.

Median metastasis diameter at presentation was 17 mm for the breast cancer patients, compared with 14 mm for the lung cancer patients (P less than .001). Breast cancer patients were significantly more likely to be symptomatic, have seizures, harbor brainstem involvement, and have leptomeningeal disease at the time of diagnosis, the researchers wrote.

“After initial brain-directed therapy, no significant differences in recurrence or treatment-based intracranial outcomes were found between the two groups,” they noted. However, neurological death was seen in 37.3% of the breast cancer group versus 19.9% of the lung cancer group (P less than .001).

 

Dr. Cagney and his coauthors said they conducted the study to identify the potential value of brain-directed MRI screening in breast cancer, which they said is “important given the impact of neurological compromise on quality of life.”

Brain metastases are common in some subsets of breast cancer patients, yet National Comprehensive Cancer Network guidelines do not recommend brain-directed screening in breast cancer, “a recommendation that is based only on expert consensus given the lack of definitive or prospective studies on this issue,” they wrote.

In light of their findings, the investigators suggest that brain-directed MRI screening is important for breast cancer patients who present with potential for intracranial involvement.

“Early identification of intracranial disease facilitates less invasive or less toxic approaches, such as stereotactic radiosurgery or careful use of promising systemic agents, rather than [whole brain radiation therapy] or neurosurgical resection.” they wrote.

In this study, whole brain radiation therapy was more common in the breast cancer group (59.9% versus 42.9% for the lung cancer group; P less than .001), the investigators noted.

Dr. Cagney and colleagues had no conflicts of interest to report.

SOURCE: Cagney DN et al. JAMA Oncol. 2018 May 17. doi: 10.1001/jamaoncol.2018.0813.

 

Despite having more extensive metastases at presentation, breast cancer patients had outcomes after brain-directed therapy similar to those of lung cancer patients, results of a retrospective, single-center study show.

The breast cancer patients had larger and more numerous brain metastases compared with the non-small-cell lung cancer (NSCLC) patients, according to study results published in JAMA Oncology.

However, median survival was not statistically different between groups, at 1.45 years for the breast cancer patients and 1.09 years for NSCLC patients (P = .06), wrote Daniel N. Cagney, MD, of Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, and his coauthors.

“This finding suggests that intracranial disease in patients with breast cancer was not more aggressive or resistant to treatment, but rather was diagnosed at a later stage,” noted Dr. Cagney and his colleagues.

They described a retrospective analysis of 349 patients with breast cancer and 659 patients with NSCLC, all treated between 2000 and 2015 at Dana-Farber/Brigham and Women’s Cancer Center.

Median metastasis diameter at presentation was 17 mm for the breast cancer patients, compared with 14 mm for the lung cancer patients (P less than .001). Breast cancer patients were significantly more likely to be symptomatic, have seizures, harbor brainstem involvement, and have leptomeningeal disease at the time of diagnosis, the researchers wrote.

“After initial brain-directed therapy, no significant differences in recurrence or treatment-based intracranial outcomes were found between the two groups,” they noted. However, neurological death was seen in 37.3% of the breast cancer group versus 19.9% of the lung cancer group (P less than .001).

 

Dr. Cagney and his coauthors said they conducted the study to identify the potential value of brain-directed MRI screening in breast cancer, which they said is “important given the impact of neurological compromise on quality of life.”

Brain metastases are common in some subsets of breast cancer patients, yet National Comprehensive Cancer Network guidelines do not recommend brain-directed screening in breast cancer, “a recommendation that is based only on expert consensus given the lack of definitive or prospective studies on this issue,” they wrote.

In light of their findings, the investigators suggest that brain-directed MRI screening is important for breast cancer patients who present with potential for intracranial involvement.

“Early identification of intracranial disease facilitates less invasive or less toxic approaches, such as stereotactic radiosurgery or careful use of promising systemic agents, rather than [whole brain radiation therapy] or neurosurgical resection.” they wrote.

In this study, whole brain radiation therapy was more common in the breast cancer group (59.9% versus 42.9% for the lung cancer group; P less than .001), the investigators noted.

Dr. Cagney and colleagues had no conflicts of interest to report.

SOURCE: Cagney DN et al. JAMA Oncol. 2018 May 17. doi: 10.1001/jamaoncol.2018.0813.