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Published in: Clinical and Translational Oncology 9/2021

01-09-2021 | Metastasis | Research Article

Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases

Authors: C. Fabregat-Franco, A. Stradella, V. Navarro, J. Linares, M. Galdeano, S. Recalde, R. Velasco, M. Simo, A. Fernadez, A. C. Venthecourt, C. Falo, S. Vazquez, M. Bergamino, R. Villanueva, S. Pernas, M. J. Gil-Gil

Published in: Clinical and Translational Oncology | Issue 9/2021

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Abstract

Purpose

Brain metastases (BM) occur in 15–35% of patients with metastatic breast cancer, conferring poor prognosis and impairing quality of life. Clinical scores have been developed to classify patients according to their prognosis. We aimed to check the utility of the Breast Graded Prognostic Assessment (B-GPA) and its modified version (mB-GPA) and compare them in routine clinical practice.

Methods

This is an ambispective study including all patients with breast cancer BM treated in a single cancer comprehensive center. We analyzed the overall survival (OS) from BM diagnosis until death. The Kaplan–Meier method and Cox proportional hazard regression model were used in the analyses. ROC curves were performed to compare both scores.

Results

We included 169 patients; median age was 50 years. HER2-positive and triple negative patients were 33.7% and 20.7%, respectively. At the last follow-up, 90% of the patients had died. Median OS was 12 months (95% confidence interval 8.0–16.0 months). OS was worse in patients with > 3 BM and in patients with triple negative subtype.

Conclusions

In our series, we confirm that B-GPA and mB-GPA scores correlated with prognosis. ROC curves showed that B-GPA and mB-GPA have similar prognostic capabilities, slightly in favor of mB-GPA.
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Literature
1.
go back to reference Zimm S, Wampler GL, Stablein D, et al. Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer. 1981;48:384–94.PubMedCrossRef Zimm S, Wampler GL, Stablein D, et al. Intracerebral metastases in solid-tumor patients: natural history and results of treatment. Cancer. 1981;48:384–94.PubMedCrossRef
2.
go back to reference Fokstuen T, Wilking N, Rutqvist LE, et al. Radiation therapy in the management of brain metastases from breast cancer. Breast Cancer Res Treat. 2000;62:211–6.PubMedCrossRef Fokstuen T, Wilking N, Rutqvist LE, et al. Radiation therapy in the management of brain metastases from breast cancer. Breast Cancer Res Treat. 2000;62:211–6.PubMedCrossRef
3.
go back to reference Griguolo G, Jacot W, Kantelhardt E, et al. External validation of Modified Breast Graded Prognostic Assessment for breast cancer patients with brain metastases: a multicentric European experience. Breast. 2018;37:36–41.PubMedCrossRef Griguolo G, Jacot W, Kantelhardt E, et al. External validation of Modified Breast Graded Prognostic Assessment for breast cancer patients with brain metastases: a multicentric European experience. Breast. 2018;37:36–41.PubMedCrossRef
4.
go back to reference Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.PubMedCrossRef Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30:419–25.PubMedCrossRef
5.
go back to reference Subbiah IM, Lei X, Weinberg JS, et al. Validation and development of a modified breast graded prognostic assessment as a tool for survival in patients with breast cancer and brain metastases. J Clin Oncol. 2015;33:2239–45.PubMedPubMedCentralCrossRef Subbiah IM, Lei X, Weinberg JS, et al. Validation and development of a modified breast graded prognostic assessment as a tool for survival in patients with breast cancer and brain metastases. J Clin Oncol. 2015;33:2239–45.PubMedPubMedCentralCrossRef
6.
7.
go back to reference Lin NU, Claus E, Sohl J, et al. Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Cancer. 2008;113:2638–45.PubMedCrossRef Lin NU, Claus E, Sohl J, et al. Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer: high incidence of central nervous system metastases. Cancer. 2008;113:2638–45.PubMedCrossRef
8.
go back to reference Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353:1659–72.PubMedCrossRef Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353:1659–72.PubMedCrossRef
9.
10.
go back to reference Perez EA, Romond EH, Suman VJ, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2—positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32:3744–52.PubMedPubMedCentralCrossRef Perez EA, Romond EH, Suman VJ, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2—positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32:3744–52.PubMedPubMedCentralCrossRef
11.
go back to reference Kast K, Schoffer O, Link T, et al. Trastuzumab and survival of patients with metastatic breast cancer. Arch Gynecol Obstet. 2017;296:303–12.PubMedCrossRef Kast K, Schoffer O, Link T, et al. Trastuzumab and survival of patients with metastatic breast cancer. Arch Gynecol Obstet. 2017;296:303–12.PubMedCrossRef
12.
go back to reference Pernas S, Tolaney SM. HER2-positive breast cancer: new therapeutic frontiers and overcoming resistance. Ther Adv Med Oncol. 2019;19(11):1758835919833519. Pernas S, Tolaney SM. HER2-positive breast cancer: new therapeutic frontiers and overcoming resistance. Ther Adv Med Oncol. 2019;19(11):1758835919833519.
13.
go back to reference Murthy RK, Loi S, Okines A, et al. Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer. N Engl J Med. 2019;382(7):597–609.PubMedCrossRef Murthy RK, Loi S, Okines A, et al. Tucatinib, trastuzumab, and capecitabine for HER2-positive metastatic breast cancer. N Engl J Med. 2019;382(7):597–609.PubMedCrossRef
14.
15.
go back to reference Moja L, Brambilla C, Compagnoni A, Pistotti V. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2006;2012(4):C006243. Moja L, Brambilla C, Compagnoni A, Pistotti V. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2006;2012(4):C006243.
16.
go back to reference Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet. 2016;388:2004–14.PubMedPubMedCentralCrossRef Mulvenna P, Nankivell M, Barton R, et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet. 2016;388:2004–14.PubMedPubMedCentralCrossRef
17.
go back to reference Trovo M, Furlan C, Polesel J, et al. Radical radiation therapy for oligometastatic breast cancer: results of a prospective phase II trial. Radiother Oncol. 2018;126:177–80.PubMedCrossRef Trovo M, Furlan C, Polesel J, et al. Radical radiation therapy for oligometastatic breast cancer: results of a prospective phase II trial. Radiother Oncol. 2018;126:177–80.PubMedCrossRef
18.
go back to reference Muacevic A, Kreth FW, Tonn JC, Wowra B. Stereotactic radiosurgery for multiple brain metastases from breast carcinoma: feasibility and outcome of a local treatment concept. Cancer. 2004;100:1705–11.PubMedCrossRef Muacevic A, Kreth FW, Tonn JC, Wowra B. Stereotactic radiosurgery for multiple brain metastases from breast carcinoma: feasibility and outcome of a local treatment concept. Cancer. 2004;100:1705–11.PubMedCrossRef
20.
go back to reference Yomo S, Hayashi M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol. 2013;113:459–65.PubMedCrossRef Yomo S, Hayashi M. The efficacy and limitations of stereotactic radiosurgery as a salvage treatment after failed whole brain radiotherapy for brain metastases. J Neurooncol. 2013;113:459–65.PubMedCrossRef
21.
go back to reference Soon YY, Tham IWK, Lim KH, et al. Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases. Cochrane Database Syst Rev. 2014;2014(3):CD09454. Soon YY, Tham IWK, Lim KH, et al. Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases. Cochrane Database Syst Rev. 2014;2014(3):CD09454.
22.
go back to reference Niwinska A, Murawska M, Pogoda K. Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann Oncol. 2010;21:942–8.PubMedCrossRef Niwinska A, Murawska M, Pogoda K. Breast cancer brain metastases: differences in survival depending on biological subtype, RPA RTOG prognostic class and systemic treatment after whole-brain radiotherapy (WBRT). Ann Oncol. 2010;21:942–8.PubMedCrossRef
23.
go back to reference Sperduto PW, Berkey B, Gaspar LE, et al. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510–4.PubMedCrossRef Sperduto PW, Berkey B, Gaspar LE, et al. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70:510–4.PubMedCrossRef
24.
go back to reference Griguolo G, Dieci MV, Giarratano T, et al. Beyond breast specific—Graded Prognostic Assessment in patients with brain metastases from breast cancer: treatment impact on outcome. J Neurooncol. 2017;131:369–76.PubMedCrossRef Griguolo G, Dieci MV, Giarratano T, et al. Beyond breast specific—Graded Prognostic Assessment in patients with brain metastases from breast cancer: treatment impact on outcome. J Neurooncol. 2017;131:369–76.PubMedCrossRef
25.
go back to reference Sperduto PW, Mesko S, Li J, et al. Beyond an updated graded Prognostic Assessment (Breast GPA): a prognostic index and trends in treatment and survival in breast cancer brain metastases from 1985 to today. Int J Radiat Oncol Biol Phys. 2020;107(2):334–43.PubMedPubMedCentralCrossRef Sperduto PW, Mesko S, Li J, et al. Beyond an updated graded Prognostic Assessment (Breast GPA): a prognostic index and trends in treatment and survival in breast cancer brain metastases from 1985 to today. Int J Radiat Oncol Biol Phys. 2020;107(2):334–43.PubMedPubMedCentralCrossRef
26.
go back to reference Sperduto PW, Kased N, Roberge D, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:2111–7.PubMedCrossRef Sperduto PW, Kased N, Roberge D, et al. Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:2111–7.PubMedCrossRef
27.
go back to reference Laakmann E, Riecke K, Goy Y, et al. Comparison of nine prognostic scores in patients with brain metastases of breast cancer receiving radiotherapy of the brain. J Cancer Res Clin Oncol. 2016;142:325–32.PubMedCrossRef Laakmann E, Riecke K, Goy Y, et al. Comparison of nine prognostic scores in patients with brain metastases of breast cancer receiving radiotherapy of the brain. J Cancer Res Clin Oncol. 2016;142:325–32.PubMedCrossRef
28.
go back to reference Tai CH, Wu CC, Hwang ME, et al. Single institution validation of a modified graded prognostic assessment of patients with breast cancer brain metastases. CNS Oncol. 2018;7:25–34.PubMedPubMedCentralCrossRef Tai CH, Wu CC, Hwang ME, et al. Single institution validation of a modified graded prognostic assessment of patients with breast cancer brain metastases. CNS Oncol. 2018;7:25–34.PubMedPubMedCentralCrossRef
29.
go back to reference Zhuang Q, Wong RX, Lian WX, et al. Validation of modified Breast Graded Prognostic Assessment for breast cancer patients with brain metastases: extra-cranial disease progression is an independent risk factor. Ann Palliat Med. 2019;8:390–400.PubMedCrossRef Zhuang Q, Wong RX, Lian WX, et al. Validation of modified Breast Graded Prognostic Assessment for breast cancer patients with brain metastases: extra-cranial disease progression is an independent risk factor. Ann Palliat Med. 2019;8:390–400.PubMedCrossRef
30.
go back to reference Finn RS, Martin M, Rugo HS, et al. Palbociclib and letrozole in advanced breast cancer. N Engl J Med. 2016;375:1925–36.CrossRefPubMed Finn RS, Martin M, Rugo HS, et al. Palbociclib and letrozole in advanced breast cancer. N Engl J Med. 2016;375:1925–36.CrossRefPubMed
31.
go back to reference Goetz MP, Toi M, Campone M, et al. MONARCH 3: abemaciclib as initial therapy for advanced breast cancer. J Clin Oncol. 2017;35:3638–46.CrossRefPubMed Goetz MP, Toi M, Campone M, et al. MONARCH 3: abemaciclib as initial therapy for advanced breast cancer. J Clin Oncol. 2017;35:3638–46.CrossRefPubMed
32.
go back to reference Hortobagyi GN. Ribociclib for the first-line treatment of advanced hormone receptor-positive breast cancer: a review of subgroup analyses from the MONALEESA-2 trial. Breast Cancer Res. 2018;20(1):123.PubMedPubMedCentralCrossRef Hortobagyi GN. Ribociclib for the first-line treatment of advanced hormone receptor-positive breast cancer: a review of subgroup analyses from the MONALEESA-2 trial. Breast Cancer Res. 2018;20(1):123.PubMedPubMedCentralCrossRef
33.
go back to reference Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med. 2018;379:1926–36.PubMedCrossRef Turner NC, Slamon DJ, Ro J, et al. Overall survival with palbociclib and fulvestrant in advanced breast cancer. N Engl J Med. 2018;379:1926–36.PubMedCrossRef
34.
35.
go back to reference Cameron D, Piccart-Gebhart MJ, Gelber RD, et al. 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial. Lancet. 2017;389:1195–205.PubMedPubMedCentralCrossRef Cameron D, Piccart-Gebhart MJ, Gelber RD, et al. 11 years’ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer: final analysis of the HERceptin Adjuvant (HERA) trial. Lancet. 2017;389:1195–205.PubMedPubMedCentralCrossRef
36.
go back to reference Prat A, Pineda E, Adamo B, et al. Clinical implications of the intrinsic molecular subtypes of breast cancer. Breast. 2015;24:S26–35.PubMedCrossRef Prat A, Pineda E, Adamo B, et al. Clinical implications of the intrinsic molecular subtypes of breast cancer. Breast. 2015;24:S26–35.PubMedCrossRef
37.
go back to reference Von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380:617–28.CrossRef Von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med. 2019;380:617–28.CrossRef
38.
go back to reference Petrelli F, Ghidini M, Lonati V, et al. The efficacy of lapatinib and capecitabine in HER-2 positive breast cancer with brain metastases: a systematic review and pooled analysis. Eur J Cancer. 2017;84:141–8.PubMedCrossRef Petrelli F, Ghidini M, Lonati V, et al. The efficacy of lapatinib and capecitabine in HER-2 positive breast cancer with brain metastases: a systematic review and pooled analysis. Eur J Cancer. 2017;84:141–8.PubMedCrossRef
39.
go back to reference Bachelot T, Romieu G, Campone M, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013;14:64–71.PubMedCrossRef Bachelot T, Romieu G, Campone M, et al. Lapatinib plus capecitabine in patients with previously untreated brain metastases from HER2-positive metastatic breast cancer (LANDSCAPE): a single-group phase 2 study. Lancet Oncol. 2013;14:64–71.PubMedCrossRef
40.
go back to reference Lin NU, Borges V, Anders C, et al. Intracranial efficacy and survival with tucatinib plus trastuzumab and capecitabine for previously treated HER2-positive breast cancer with brain metastases in the HER2CLIMB trial. J Clin Oncol. 2020;38(23):2610–9.PubMedCrossRefPubMedCentral Lin NU, Borges V, Anders C, et al. Intracranial efficacy and survival with tucatinib plus trastuzumab and capecitabine for previously treated HER2-positive breast cancer with brain metastases in the HER2CLIMB trial. J Clin Oncol. 2020;38(23):2610–9.PubMedCrossRefPubMedCentral
41.
go back to reference Cardoso F, Senkus E, Costa A, et al. 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4) †. Immune-related Pathol Response Criteria. 2018;29:1634–57. Cardoso F, Senkus E, Costa A, et al. 4th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 4) †. Immune-related Pathol Response Criteria. 2018;29:1634–57.
Metadata
Title
Validation and comparison of Breast Graded Prognostic Assessment scores in patients with breast cancer and brain metastases
Authors
C. Fabregat-Franco
A. Stradella
V. Navarro
J. Linares
M. Galdeano
S. Recalde
R. Velasco
M. Simo
A. Fernadez
A. C. Venthecourt
C. Falo
S. Vazquez
M. Bergamino
R. Villanueva
S. Pernas
M. J. Gil-Gil
Publication date
01-09-2021
Publisher
Springer International Publishing
Published in
Clinical and Translational Oncology / Issue 9/2021
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI
https://doi.org/10.1007/s12094-021-02577-x

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