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BRCA1 Mutations Associated With Increased Risk of Brain Metastases in Breast Cancer

A 1

2 Matched-pair Analysis

Zavitsanos, Peter J., MD*; Wazer, David E., MD*; Hepel, Jaroslaw T., MD*; Wang, Yihong, MD; Singh, Kamaljeet, MD; Leonard, Kara L., MD*

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1252–1256
doi: 10.1097/COC.0000000000000466
Original Articles: Breast
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Background: Brain metastases (BM) occur in ∼5% of breast cancer patients. BRCA1-associated cancers are often basal-like and basal-like cancers are known to have a predilection for central nervous system metastases. We performed a matched-pair analysis of breast cancer patients with and without BRCA mutations and compared the frequency of BM in both groups.

Materials and Methods: From a database of 1935 patients treated for localized breast cancer at our institution from 2009 to 2014 we identified 20 patients with BRCA1 or BRCA2 mutations and manually matched 40 patients without BRCA mutations accounting for age, stage, estrogen receptor expression, and human epidermal growth factor receptor 2 (HER2) expression. Comparisons of freedom from brain metastasis, brain metastasis-free survival, and overall survival were made using the log rank test. Testing for a basal-type phenotype using the immunohistochemistry definition (ER/PR/HER2 and either CK 5/6+ or EGFR+) was performed for BRCA+ patients who developed BM and their matched controls.

Results: We analyzed 60 patients: 20 BRCA+ and 40 were matched controls. Median follow-up was 37 and 49 months, respectively. Three years freedom from brain metastasis was 84% for BRCA+ patients and 97% for BRCA controls (P=0.049). Three years brain metastasis-free survival was 84% and 97% for the BRCA+ and controls, respectively (P=0.176). Mean time to brain failure was 11 months from diagnosis for the BRCA+ patients. All 3 BRCA1+ patients who developed BM were of a basal-type triple negative phenotype.

Conclusions: Breast cancer patients with germline BRCA1 mutations appear to have a shorter interval to brain progression while accounting for confounding factors.

Departments of *Radiation Oncology

Pathology, Warren Alpert School of Medicine, Brown University, Rhode Island Hospital

Department of Pathology, Warren Alpert School of Medicine, Brown University, Women and Infants Hospital, Providence, RI

The authors declare no conflicts of interest.

Reprints: Peter J. Zavitsanos, MD, Department of Radiation Oncology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903. E-mail: peter.zavitsanos@lifespan.org.

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