
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.127
vdae090.127
Final Category: Supportive Care, Palliative Care and QOL
AcademicSubjects/MED00300
AcademicSubjects/MED00310
QSPC-12 CNS-ONLY DISEASE IS ASSOCIATED WITH LONGER SURVIVAL BUT HIGH CNS-RELATED MORTALITY IN PATIENTS WITH HER2+ BREAST CANCER
Ferraro Emanuela Memorial Sloan Kettering Cancer Center, New York/NY, USA

Reiner Anne S Memorial Sloan Kettering Cancer Center, New York/NY, USA

Nassif Rabih Bou Memorial Sloan Kettering Cancer Center, New York/NY, USA

Tosi Umberto Memorial Sloan Kettering Cancer Center, New York/NY, USA

Brown Samantha Memorial Sloan Kettering Cancer Center, New York/NY, USA

Zeller Sabrina zellers@mskcc.org, New York/NY, USA

Dang Chau T Memorial Sloan Kettering Cancer Center, New York/NY, USA

Seidman Andrew D Memorial Sloan Kettering Cancer Center, New York/NY, USA

Panageas Katherine Memorial Sloan Kettering Cancer Center, New York/NY, USA

Moss Nelson Memorial Sloan Kettering Cancer Center, New York/NY, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i38i39
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

BACKGROUND

Due to poorer drugs efficacy in the CNS than extracranially, patients with metastatic HER2+ breast cancer and CNS-only disease are a growing population. Here, we aimed to report the overall survival (OS) and CNS-related death in HER2+ MBC patients with CNS metastasis by disease distribution.

METHODS

Patients with HER2+ MBC with CNS disease including BrM, leptomeningeal (LMD) and/or dural metastasis treated in our Institution between 8/2010 and 4/2022 were included. Extracranial metastasis (ECM) was evaluated at the time of CNS metastasis and at last follow-up/death. CNS-related death was defined as death from tumor-related brain injury, functional deficits/seizures, and/or complications of brain-directed therapies. OS was estimated using Kaplan-Meier methodology.

RESULTS

The cohort comprised 274 patients. At CNS metastasis diagnosis, 72/274 (26%) presented with CNS-only disease (63 without prior ECM diagnosis, and 9 with prior ECM in complete response), and 200/274 (73%) with concomitant ECM. Two patients had unknown ECM status at CNS disease diagnosis. Among patients with CNS-only disease, 34/72 (47%) never developed ECM progression by the time of their last follow-up/death. Patients with CNS-only disease had longer OS than patients with CNS+ECM: 3.48 years (95%CI: 2.10-5.14) versus 1.96 years (95%CI: 1.62-2.27), respectively (p=0.017).The cumulative incidence of CNS-related death at 3 years was 32.91% (27.2-38.7%), and did not differ between CNS+ECM versus CNS-only groups, p=0.14, despite higher use of neurosurgical resection in the latter group. Conversely, death due to other causes was more likely to occur in the CNS+ECM group than CNS-only, p=<0.001. LMD and whole-brain radiotherapy were independently associated with CNS-related death [HR=1.88 (95%CI: 1.20-2.95), p=0.006; HR=1.69 (95%CI: 1.12-2.54), p=0.01].

CONCLUSIONS

With higher rates of local therapy, patients with CNS-only disease had longer survival but high rates of CNS-related death owing to the treatable but ultimately refractory disease nature. Novel therapies with CNS efficacy are urgently needed.
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