Published January 2022
| Version v1
Journal article
Clinicopathological characteristics and prognosis of breast cancer patients with isolated central nervous system metastases in the multicentre ESME database
Creators
- Carausu, Marcela
- Carton, Matthieu
- Cabel, Luc
- Patsouris, Anne
- Levy, Christelle
- Verret, Benjamin
- Pasquier, David
- Debled, Marc
- Gonçalves, Anthony
- Desmoulins, Isabelle
- Lecouillard, Isabelle
- Bachelot, Thomas
- Ferrero, Jean-Marc
- Eymard, Jean-Christophe
- Mouret-Reynier, Marie-Ange
- Chevrot, Michaël
- de Maio, Eleonora
- Uwer, Lionel
- Frénel, Jean-Sébastien
- Leheurteur, Marianne
- Petit, Thierry
- Darlix, Amélie
- Bozec, Laurence
Contributors
Others:
- Institut Curie - Saint Cloud (ICSC)
- Institut Curie [Paris]
- Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO) ; UNICANCER
- Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC) ; Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)
- Institut Gustave Roussy (IGR)
- Centre de Recherche en Informatique, Signal et Automatique de Lille - UMR 9189 (CRIStAL) ; Centrale Lille-Université de Lille-Centre National de la Recherche Scientifique (CNRS)
- Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille) ; Université de Lille-UNICANCER
- Institut Bergonié [Bordeaux] ; UNICANCER
- Centre de Recherche en Cancérologie de Marseille (CRCM) ; Aix Marseille Université (AMU)-Institut Paoli-Calmettes (IPC) ; Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
- Service d'oncogénétique [Centre georges-François Leclerc] ; Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL) ; UNICANCER-UNICANCER
- CRLCC Eugène Marquis (CRLCC) ; UNICANCER
- Centre Léon Bérard [Lyon]
- Centre de Lutte contre le Cancer Antoine Lacassagne [Nice] (UNICANCER/CAL) ; UNICANCER-Université Côte d'Azur (UniCA)
- Institut Jean Godinot [Reims] ; UNICANCER
- Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP) ; UNICANCER
- UNICANCER
- Institut Claudius Regaud
- Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037) ; Université Toulouse III - Paul Sabatier (UT3) ; Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL) ; UNICANCER
- CRLCC René Gauducheau
- Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen (CLCC Henri Becquerel)
- Centre Paul Strauss (CRLCC Paul Strauss) ; UNICANCER
- Institut régional de Cancérologie de Montpellier (ICM)
- Institut de Génomique Fonctionnelle (IGF) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)
- The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Epidemiological Strategy and Medical Economics (ESME) metastatic breast cancer database receives financial support from an industrial consortium (Roche, Pfizer, AstraZeneca, MSD, Eisai and Daiichi Sankyo). Data collection, analysis and publication are managed entirely by UNICANCER independently of the industrial consortium.
Description
Background: As a result of progress in diagnosis and treatment, there is a growing prevalence of metastatic breast cancer (MBC) with isolated CNS metastases. This study describes the largest-to-date real-life cohort of this clinical setting and compares it to other clinical presentations.Methods: We retrospectively analysed the French Epidemiological Strategy and Medical Economics (ESME) MBC database including patients who initiated treatment for MBC between 2008 and 2016. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Descriptive statistics and multivariate Cox model were used.Results: Of 22,266 patients, 647 (2.9%) and 929 (4.2%) patients had isolated first-site CNS metastases or combined with extra-CNS metastases, with longer OS for the group with isolated CNS metastases (16.9 versus 13.9 months, adjusted HR = 1.69 (95% CI: 1.50–1.91), p < 0.001). Among the 541 (2.4%) patients with isolated CNS metastases and no intrathecal therapy (excluding leptomeningeal metastases), HER2+ cases were preponderant over TN or HR+ /HER2− cases (41.6% versus 26.1% versus 28.5%, respectively, p < 0.01). The treatment strategy consisted of a combination of local treatment and systemic therapy (49.2%), local treatment only (35.5%) or systemic therapy only (11.4%), or symptomatic therapy only (3.9%). Median PFS was 6.1 months (95% CI: 5.7–6.8). Median OS was 20.7 months (95% CI: 17.3–24.3), reaching 37.9 months (95% CI: 25.9–47.6) in the HR+ /HER2+ subgroup. Older age, TN subtype, MBC-free interval of 6–12 months, lower performance status, and WBRT were associated with poorer survival. Patients who received systemic therapy within 3 months from MBC diagnosis had longer OS (24.1 versus 16.1 months, p = 0.031), but this was not significant on multivariate analysis [HR = 1.0 (95% CI: 0.7–1.3), p = 0.806].Conclusions: Patients with isolated CNS metastases at MBC diagnosis represent a distinct population for which the role of systemic therapy needs to be further investigated in prospective studies.
Abstract
International audienceAdditional details
Identifiers
- URL
- https://hal.science/hal-03867853
- URN
- urn:oai:HAL:hal-03867853v1
Origin repository
- Origin repository
- UNICA