Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL, 33612, USA.
Department of Neurology, Medical College of Georgia, Augusta, GA, USA.
Breast Cancer Res. 2024 Mar 29;26(1):55. doi: 10.1186/s13058-024-01789-7.
Breast cancer-related leptomeningeal disease (BC-LMD) is a dire diagnosis for 5-8% of patients with breast cancer (BC). We conducted a retrospective review of BC-LMD patients diagnosed at Moffitt Cancer Center from 2011 to 2020, to determine the changing incidence of BC-LMD, factors which are associated with the progression of BC CNS metastasis to BC-LMD, and factors which are associated with OS for patients with BC-LMD.
Patients with BC and brain/spinal metastatic disease were identified. For those who eventually developed BC-LMD, we used Kaplan-Meier survival curve, log-rank test, univariable, and multivariate Cox proportional hazards regression model to identify factors affecting time from CNS metastasis to BC-LMD and OS.
128 cases of BC-LMD were identified. The proportion of BC-LMD to total BC patients was higher between 2016 and 2020 when compared to 2011-2015. Patients with HR+ or HER2 + BC experienced longer times between CNS metastasis and LMD than patients with triple-negative breast cancer (TNBC). Systemic therapy and whole-brain radiation therapy (WBRT) was associated with prolonged progression to LMD in all patients. Hormone therapy in patients with HR + BC were associated with a delayed BC-CNS metastasis to LMD progression. Lapatinib treatment was associated with a delayed progression to LMD in patients with HER2 + BC. Patients with TNBC-LMD had shorter OS compared to those with HR + and HER2 + BC-LMD. Systemic therapy, intrathecal (IT) therapy, and WBRT was associated with prolonged survival for all patients. Lapatinib and trastuzumab therapy was associated with improved OS in patients with HER2 + BC-LMD.
Increasing rates of BC-LMD provide treatment challenges and opportunities for clinical trials. Prospective trials testing lapatinib and/or similar tyrosine kinase inhibitors, IT therapies, and combination treatments are urgently needed.
乳腺癌相关的软脑膜疾病（BC-LMD）是 5-8%乳腺癌（BC）患者的严重诊断。我们对 2011 年至 2020 年在 Moffitt 癌症中心诊断为 BC-LMD 的患者进行了回顾性研究，以确定 BC-LMD 的发病率变化、与 BC 中枢神经系统转移进展为 BC-LMD 相关的因素，以及与 BC-LMD 患者 OS 相关的因素。
确定患有 BC 和脑/脊髓转移疾病的患者。对于那些最终发展为 BC-LMD 的患者，我们使用 Kaplan-Meier 生存曲线、对数秩检验、单变量和多变量 Cox 比例风险回归模型来确定影响从 CNS 转移到 BC-LMD 和 OS 的时间的因素。
确定了 128 例 BC-LMD 病例。与 2011-2015 年相比，2016-2020 年期间，BC-LMD 占总 BC 患者的比例更高。HR+或 HER2+BC 患者从 CNS 转移到 LMD 的时间比三阴性乳腺癌（TNBC）患者长。所有患者的全身治疗和全脑放疗（WBRT）与进展为 LMD 时间延长相关。HR+BC 患者的激素治疗与 BC-CNS 转移至 LMD 进展延迟相关。曲妥珠单抗治疗与 HER2+BC 患者进展为 LMD 延迟相关。与 HR+和 HER2+BC-LMD 患者相比，TNBC-LMD 患者的 OS 更短。全身治疗、鞘内（IT）治疗和 WBRT 与所有患者的生存延长相关。曲妥珠单抗和拉帕替尼治疗与 HER2+BC-LMD 患者的 OS 改善相关。
BC-LMD 发生率的增加为临床试验提供了治疗挑战和机遇。迫切需要进行前瞻性试验，以测试拉帕替尼和/或类似的酪氨酸激酶抑制剂、IT 治疗和联合治疗。
