Long-term Survival of Patients with Breast Cancer and Brain Metastases: ‘The experience of the 2^nd Oncology Department of Metropolitan Hospital and a brief review of the literature’

Background: Novel therapeutic approaches and new compounds during the last decade have prolonged survival of breast cancer patients with metastatic disease, resulting in higher incidence of central nervous system (CNS) metastases. Many of these patients live longer than expected.

Patients and methods: We reviewed breast cancer patients with brain metastases from our department, living longer than 1 year. Our purposes were to present patient and treatment characteristics and correlate them with disease outcome. Moreover, we aimed at reviewing the current literature.

Results: We detected 20 women with brain metastases from breast cancer, living longer than 1 year. The mean age was 41 years (range 22-61 years). One (5%) woman had luminal A breast cancer type, four (20%) patients had luminal B and HER2 negative, nine (45%) patients luminal B and HER2 positive, four (20%) patients HER2 enriched and two (10%) patients had triple-negative breast cancer. Most of them (70%) had infiltrating ductal histological type and grade 3. Moreover, the majority had known metastatic disease when brain metastases appeared. The most common sites of disease were lung, liver and bone. Median time from breast cancer diagnosis until the presence of CNS metastases was 44 months (range 6-204 months). The progression free survival (PFS) of the most chemotherapeutic schedules was according to the literature. However, PFS of some compounds exceeded all expectations. Median time of survival was 25 months (range 13-116 months). Ten patients are still alive, having achieved a median survival rate of 35 months (range 17-78 months).

Conclusion: The combination of surgery, radiotherapy, chemotherapy and anti HER2 treatments is at present the best way to extend the OS and improve the quality of life of breast cancer patients with brain metastases. Prognostic markers for assessing brain metastases are required. Application of prophylactic treatment for these patients is under consideration.