TY - JOUR
T1 - Beyond an Updated Graded Prognostic Assessment (Breast GPA)
T2 - A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today
AU - Sperduto, Paul W.
AU - Mesko, Shane
AU - Li, Jing
AU - Cagney, Daniel
AU - Aizer, Ayal
AU - Lin, Nancy U.
AU - Nesbit, Eric
AU - Kruser, Tim J.
AU - Chan, Jason
AU - Braunstein, Steve
AU - Lee, Jessica
AU - Kirkpatrick, John P.
AU - Breen, Will
AU - Brown, Paul D.
AU - Shi, Diana
AU - Shih, Helen A.
AU - Soliman, Hany
AU - Sahgal, Arjun
AU - Shanley, Ryan
AU - Sperduto, William
AU - Lou, Emil
AU - Everett, Ashlyn
AU - Boggs, Drexell Hunter
AU - Masucci, Laura
AU - Roberge, David
AU - Remick, Jill
AU - Plichta, Kristin
AU - Buatti, John M.
AU - Jain, Supriya
AU - Gaspar, Laurie E.
AU - Wu, Cheng Chia
AU - Wang, Tony J.C.
AU - Bryant, John
AU - Chuong, Michael
AU - Yu, James
AU - Chiang, Veronica
AU - Nakano, Toshimichi
AU - Aoyama, Hidefumi
AU - Mehta, Minesh P.
N1 - Funding Information:
Grant support was received from the National Institutes of Health (NIH) grant number UL1TR002494 from the National Center for Advancing Translational Sciences (NCATS). Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Minnesota. In addition, the study was supported by NIH grant number P30 CA77598 using the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and the NCATS. Disclosures: A.S. reports being an advisor/consultant with Abbvie, Merck, Roche, Varian (Medical Advisory Group), Elekta (Gamma Knife Icon), BrainLAB, and VieCure (Medical Advisory Board); is a board member of the International Stereotactic Radiosurgery Society (ISRS); has presented past educational seminars with Elekta AB, Accuray Inc, Varian (CNS Teaching Faculty), BrainLAB, Medtronic Kyphon; receives research grant from Elekta AB; and received travel accommodations or paid expenses by Elekta, Varian, BrainLAB. A.S. also belongs to the Elekta MR Linac Research Consortium, Elekta Spine, Oligometastases, and Linac Based SRS Consortia. M.P.M. discloses consulting relationships with IBA, Varian, Oncoceutics, Celgene, Abbvie, Astra-Zeneca, Tocagen, and Blue Earth Diagnostics, none of which pertain to the material in the manuscript. In addition, his institution has received research funding from Novocure. He also serves on the Board of Directors of Oncoceutics.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Purpose: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. Methods and Materials: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. Results: Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). Conclusions: MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
AB - Purpose: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts. Methods and Materials: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively. Results: Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01). Conclusions: MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.
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U2 - 10.1016/j.ijrobp.2020.01.051
DO - 10.1016/j.ijrobp.2020.01.051
M3 - Article
C2 - 32084525
AN - SCOPUS:85081929812
VL - 107
SP - 334
EP - 343
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
SN - 0360-3016
IS - 2
ER -