Brain metastases in Asian HER2-positive breast cancer patients: anti-HER2 treatments and their impact on survival

Y S Yap, G H Cornelio, B C R Devi, C Khorprasert, S B Kim, T Y Kim, S C Lee, Y H Park, J H Sohn, N Sutandyo, D W Y Wong, M Kobayashi, S H Landis, E M Yeoh, H Moon, J Ro, Y S Yap, G H Cornelio, B C R Devi, C Khorprasert, S B Kim, T Y Kim, S C Lee, Y H Park, J H Sohn, N Sutandyo, D W Y Wong, M Kobayashi, S H Landis, E M Yeoh, H Moon, J Ro

Abstract

Background: In Asia, large-scale studies on anti-HER2 treatment in HER2-positive breast cancer patients with brain metastases are limited. We studied the treatment patterns of these patients in Asia to evaluate the impact of anti-HER2 treatment on the time to occurrence of brain metastases (TTBM) and survival after brain metastasis (BM).

Methods: A retrospective study of HER2-positive breast cancer patients diagnosed with BM between January 2006 and December 2008 in six Asian countries was conducted. Demographics, tumour characteristics, treatment details, and events dates were collected from medical records.

Results: Data from 280 patients were analysed. Before BM, 63% received anti-HER2 treatment. These patients had significantly longer TTBM than those without anti-HER2 treatment (median 33 vs 19 months; P<0.002). After BM, 93% received radiotherapy, 57% received chemotherapy, and 41% received anti-HER2 treatment (trastuzumab and/or lapatinib). Use of both anti-HER2 agents, primarily sequentially, after BM demonstrated the longest survival after BM and was associated with a significant survival benefit over no anti-HER2 treatment (median 26 vs 6 months; hazard ratio 0.37; 95% CI 0.19-0.72).

Conclusion: Anti-HER2 treatment before BM was associated with longer TTBM. Anti-HER2 treatment after BM was associated with a survival benefit, especially when both trastuzumab and lapatinib were utilised.

Conflict of interest statement

YS Yap and N Sutandyo have received honoraria from GlaxoSmithKline. DWY Wong has received honoraria from Roche. M Kobayashi is an ex-employee of GlaxoSmithKline. SH Landis, EM Yeoh and H Moon are employees of GlaxoSmithKline. M Kobayashi, SH Landis, EM Yeoh and H Moon hold stock ownership in GlaxoSmithKline. J Ro has acted as an advisor and received honoraria from GlaxoSmithKline. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient cohort. FISH, fluorescence in situ hybridisation; IHC, immunohistochemistry.
Figure 2
Figure 2
Overall survival (OS) after brain metastasis (BM) by anti-HER2 treatment received after diagnosis of brain metastasis (BM). (A) Anti-HER2 treatment vs no anti-HER2 treatment. Median OS after BM for all patients was 10.9 months (95% CI 9.0–11.9). (B) Both agents vs lapatinib only vs trastuzumab only vs no anti-HER2 treatment. Median OS after BM for all patients was 10.9 months (95% CI 9.0–11.9). *Trastuzumab and lapatinib given sequentially or concomitantly.

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