Ono Makiko, Ando Masashi, Yunokawa Mayu, Nakano Eriko, Yonemori Kan, Matsumoto Koji, Kouno Tsutomu, Shimizu Chikako, Tamura Kenji, Katsumata Noriyuki, Fujiwara Yasuhiro
Breast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
Int J Clin Oncol. 2009 Feb;14(1):48-52. doi: 10.1007/s10147-008-0797-8. Epub 2009 Feb 20.
Recently, a high rate of brain metastases has been reported among patients with human epidermal growth factor receptor (HER2)-overexpressing metastatic breast cancer who were treated with trastuzumab. The present study examined risk factors for the development of brain metastasis in patients with HER2-overexpressing breast cancer who were treated with trastuzumab.
We retrospectively reviewed 204 patients with HER-2-overexpressing breast cancer who were treated with a trastuzumab-containing regimen between 1999 and 2006. Patients with clinical symptoms were diagnosed as having brain metastases when brain magnetic resonance imaging (MRI) or a computed tomography (CT) scan revealed positive findings for brain metastases. The median follow-up time of this cohort was 53.6 months.
Among the patients who received a trastuzumab-containing regimen, 74 patients (36.3%) developed brain metastases. The median survival from the diagnosis of brain metastases was 13.5 months (95% confidence interval [CI], 12.2-14.7 months). The median time interval between the beginning of trastuzumab treatment and the diagnosis of brain metastases was 13.6 months (range, 0.0-45.8 months). Among patients with brain metastases, the median overall survival period was 39 months. A multivariate logistic regression analysis showed that age (<or=50 years), recurrent breast cancer, and liver metastases were significant risk factors for the development of brain metastases.
Patients with HER2-overexpressing breast cancer treated with trastuzumab had a high incidence of brain metastases (36.3%). Routine screening for brain metastases 1 year after the start of trastuzumab treatment, may be warranted in younger patients (</=50 years) who had recurrent breast cancer with liver metastases.
最近，有报道称在接受曲妥珠单抗治疗的人表皮生长因子受体（HER2）过表达的转移性乳腺癌患者中，脑转移发生率很高。本研究调查了接受曲妥珠单抗治疗的HER2过表达乳腺癌患者发生脑转移的危险因素。
我们回顾性分析了1999年至2006年间接受含曲妥珠单抗方案治疗的204例HER-2过表达乳腺癌患者。有临床症状的患者，当脑磁共振成像（MRI）或计算机断层扫描（CT）显示脑转移阳性结果时，被诊断为脑转移。该队列的中位随访时间为53.6个月。
在接受含曲妥珠单抗方案治疗的患者中，74例（36.3%）发生了脑转移。从脑转移诊断开始的中位生存期为13.5个月（95%置信区间[CI]，12.2 - 14.7个月）。曲妥珠单抗治疗开始至脑转移诊断的中位时间间隔为13.6个月（范围，0.0 - 45.8个月）。在发生脑转移的患者中，中位总生存期为39个月。多因素逻辑回归分析显示，年龄（≤50岁）、复发性乳腺癌和肝转移是发生脑转移的显著危险因素。
接受曲妥珠单抗治疗的HER2过表达乳腺癌患者脑转移发生率很高（36.3%）。对于年龄较小（≤50岁）、患有复发性乳腺癌且有肝转移的患者，在曲妥珠单抗治疗开始1年后进行脑转移的常规筛查可能是必要的。
