Clinical

BJC Open article

British Journal of Cancer (2004) 91, 639–643. doi:10.1038/sj.bjc.6601970 www.bjcancer.com
Published online 20 July 2004

Incidence of cerebral metastases in patients treated with trastuzumab for metastatic breast cancer

A J Clayton1, S Danson1, S Jolly1, W D J Ryder1, P A Burt1, A L Stewart1, P M Wilkinson1, R S Welch1, B Magee1, G Wilson1, A Howell1 and A M Wardley1

1Departments of Medical and Clinical Oncology, Christie Hospital NHS Trust, Wilmslow Road, Withington, Manchester, M20 4BX, UK

Correspondence: Dr AM Wardley, E-mail: Andrew.Wardley@christie-tr.nwest.nhs.uk

Received 2 February 2004; Revised 28 April 2004; Accepted 3 May 2004
Advance online publication 20 July 2004

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Abstract

Trastuzumab is an effective treatment for patients with metastatic breast cancer (MBC) that overexpresses HER-2. A high incidence of brain metastases (BM) has been noted in patients receiving trastuzumab. A retrospective chart review was conducted of 100 patients commencing trastuzumab for metastatic breast cancer from July 1999 to December 2002, at the Christie Hospital. Seven patients were excluded; five patients developed central nervous system metastases prior to starting trastuzumab, and inadequate data were available for two. Out of the remaining 93 patients, 23 (25%) have developed BM to date. In all, 46 patients have died, and of these 18 (39%) have been diagnosed with BM prior to death. Of the 23 patients developing BM, 18 (78%) were hormone receptor negative and 18 (78%) had visceral disease. Univariate analysis showed a significant association between the development of cerebral disease and both hormone receptor status and the presence of visceral disease. In conclusion, a high proportion of patients with MBC treated with trastuzumab develop symptomatic cerebral metastases. HER-2-positive breast cancer may have a predilection for the brain, or trastuzumab therapy may change the disease pattern by prolonging survival. New strategies to address this problem require investigation in this group of patients.

Keywords:

trastuzumab; brain metastases; breast cancer

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