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Annals of Oncology Advance Access published online on July 29, 2008
Annals of Oncology, doi:10.1093/annonc/mdn539
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Trastuzumab treatment beyond brain progression in HER2-positive metastatic breast cancer

I. H. Park1, J. Ro1,*, K. S. Lee1, B. H. Nam2, Y. Kwon1 and K. H. Shin1

1 Center for Breast Cancer, National Cancer Center, Goyang, Gyeonggi, Korea
2 Center for Clinical Trials, National Cancer Center, Goyang, Gyeonggi, Korea

* Address for correspondence: Dr J. Ro, Center for Breast Cancer, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-769, Korea. Tel: +82-31-920-1610; E-mail: jungsro{at}ncc.re.kr

Background: Although trastuzumab therapy improves survival in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer, 40% of patients develop brain metastasis (BM) even when extracranial disease is under control. We studied whether trastuzumab therapy beyond or after BM was beneficial to patients with BM.

Patients and methods: The effect of trastuzumab on survival after BM was analyzed in 78 HER2-positive breast cancer patients. Patients were grouped according to trastuzumab therapy; no treatment and treatment before and after BM were diagnosed.

Results: Overall survival after the diagnosis of BM as well as time to progression (TTP) of intracranial tumors was prolonged in patients who received trastuzumab after BM was diagnosed. Conversely, BM occurred much later in patients who received trastuzumab before BM. In the multivariate Cox regression model, age at BM <50 years, disease-free interval ≥24 months, TTP of intracranial tumor ≥4.8 months, and trastuzumab treatment after BM were significantly associated with longer survival after the onset of BM.

Conclusions: Trastuzumab therapy after the onset of BM in HER2-positive breast cancer patients is associated with a significant survival benefit after BM diagnosis compared with patients who never received or completed trastuzumab before the BM diagnosis.

brain metastasis, HER2-positive breast cancer, trastuzumab

Received for publication May 21, 2008. Accepted for publication June 30, 2008.


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