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Treatment and prognosis of leptomeningeal disease secondary to metastatic breast cancer: A single-centre experience.

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Date
2017-12
ICR Author
Smith, Ian
Johnston, Stephen
Turner, Nicholas
O'Brien, Mary
Marsden,
Kingston, Belinda
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Author
Kingston, B
Kayhanian, H
Brooks, C
Cox, N
Chaabouni, N
Redana, S
Kalaitzaki, E
Smith, I
O'Brien, M
Johnston, S
Parton, M
Noble, J
Stanway, S
Ring, A
Turner, N
Okines, A
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Type
Journal Article
Metadata
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Abstract
Purpose Leptomeningeal disease (LMD) is an uncommon complication of advanced breast cancer. The prognosis is poor, and although radiotherapy (RT), systemic and intra-thecal (IT) chemotherapy are accepted treatment modalities, efficacy data are limited. This study was designed to evaluate potential predictors of survival in this patient group.Methods Breast cancer patients with LMD diagnosed by MRI in a 10-year period (2004-2014) were identified from electronic patient records. PFS and OS estimates were calculated using Kaplan-Meier method, with planned sub-group analysis by treatment modality. Cox regression was employed to identify significant prognostic variables.Results We identified 182 eligible patients; all female, median age at LMD diagnosis 52.5 years (range 23-80). Ninety patients (49.5%) were ER positive/HER2 negative; 48 (26.4%) were HER2 positive, and 27 (14.8%) were triple negative. HER2 status was unknown in 17 (9.3%). Initial management of LMD was most commonly whole or partial brain RT in 62 (34.1%), systemic therapy in 45 (24.7%) or supportive care alone in 37 (20.3%). Fourteen patients (7.7%) underwent IT chemotherapy, of whom two also received IT trastuzumab. From diagnosis of LMD, the median PFS was 3.9 months (95%CI 3.2-5.0) and median OS was 5.4 months (95%CI 4.2-6.6). Patients treated with systemic therapy had the longest OS (median 8.8 months, 95%CI 5.5-11.1), compared to RT; 6.1 months (95%CI 4.2-7.9 months), IT therapy; 2.9 months (95%CI 1.2-5.8) and supportive care; 1.7 months (95%CI 0.9-3.0). On multivariable analysis, triple negative histology, concomitant brain metastases, and LMD involving both the brain and spinal cord were associated with poor OS.Conclusions Breast cancer patients with triple negative LMD, concomitant brain metastases or LMD affecting both the spine and brain have the poorest prognosis. Clinical trials to identify more effective treatments for these patients are urgently needed.
URI
https://repository.icr.ac.uk/handle/internal/937
DOI
https://doi.org/10.1016/j.breast.2017.07.015
Collections
  • Breast Cancer Research
  • Clinical Studies
Subject
Brain
Spinal Cord
Humans
Breast Neoplasms
Brain Neoplasms
Receptor, erbB-2
Receptors, Estrogen
Receptors, Progesterone
Antineoplastic Combined Chemotherapy Protocols
Disease-Free Survival
Infusions, Intravenous
Survival Rate
Proportional Hazards Models
Retrospective Studies
Age Factors
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Meningeal Carcinomatosis
Young Adult
Kaplan-Meier Estimate
Infusions, Spinal
Trastuzumab
Antineoplastic Agents, Immunological
Research team
Endocrine Therapy Resistance
Molecular Oncology
Medicine (RMH Smith Cunningham)
Treatment of thoracic tumours
Language
eng
Date accepted
2017-07-19
License start date
2017-12
Citation
Breast (Edinburgh, Scotland), 2017, 36 pp. 54 - 59

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