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. 2020 Jun 1;107(2):334-343.
doi: 10.1016/j.ijrobp.2020.01.051. Epub 2020 Feb 19.

Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today

Paul W Sperduto  1 , Shane Mesko  2 , Jing Li  2 , Daniel Cagney  3 , Ayal Aizer  3 , Nancy U Lin  3 , Eric Nesbit  4 , Tim J Kruser  4 , Jason Chan  5 , Steve Braunstein  5 , Jessica Lee  6 , John P Kirkpatrick  6 , Will Breen  7 , Paul D Brown  7 , Diana Shi  8 , Helen A Shih  8 , Hany Soliman  9 , Arjun Sahgal  9 , Ryan Shanley  10 , William Sperduto  6 , Emil Lou  10 , Ashlyn Everett  11 , Drexell Hunter Boggs  11 , Laura Masucci  12 , David Roberge  12 , Jill Remick  13 , Kristin Plichta  14 , John M Buatti  14 , Supriya Jain  15 , Laurie E Gaspar  15 , Cheng-Chia Wu  16 , Tony J C Wang  16 , John Bryant  17 , Michael Chuong  17 , James Yu  18 , Veronica Chiang  18 , Toshimichi Nakano  19 , Hidefumi Aoyama  19 , Minesh P Mehta  17
Affiliations

Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today

Paul W Sperduto et al. Int J Radiat Oncol Biol Phys. .

Erratum in

Abstract

Purpose: Brain metastases are a common sequelae of breast cancer. Survival varies widely based on diagnosis-specific prognostic factors (PF). We previously published a prognostic index (Graded Prognostic Assessment [GPA]) for patients with breast cancer with brain metastases (BCBM), based on cohort A (1985-2007, n = 642), then updated it, reporting the effect of tumor subtype in cohort B (1993-2010, n = 400). The purpose of this study is to update the Breast GPA with a larger contemporary cohort (C) and compare treatment and survival across the 3 cohorts.

Methods and materials: A multi-institutional (19), multinational (3), retrospective database of 2473 patients with breast cancer with newly diagnosed brain metastases (BCBM) diagnosed from January 1, 2006, to December 31, 2017, was created and compared with prior cohorts. Associations of PF and treatment with survival were analyzed. Kaplan-Meier survival estimates were compared with log-rank tests. PF were weighted and the Breast GPA was updated such that a GPA of 0 and 4.0 correlate with the worst and best prognoses, respectively.

Results: Median survival (MS) for cohorts A, B, and C improved over time (from 11, to 14 to 16 months, respectively; P < .01), despite the subtype distribution becoming less favorable. PF significant for survival were tumor subtype, Karnofsky Performance Status, age, number of BCBMs, and extracranial metastases (all P < .01). MS for GPA 0 to 1.0, 1.5-2.0, 2.5-3.0, and 3.5-4.0 was 6, 13, 24, and 36 months, respectively. Between cohorts B and C, the proportion of human epidermal receptor 2 + subtype decreased from 31% to 18% (P < .01) and MS in this subtype increased from 18 to 25 months (P < .01).

Conclusions: MS has improved modestly but varies widely by diagnosis-specific PF. New PF are identified and incorporated into an updated Breast GPA (free online calculator available at brainmetgpa.com). The Breast GPA facilitates clinical decision-making and will be useful for stratification of future clinical trials. Furthermore, these data suggest human epidermal receptor 2-targeted therapies improve clinical outcomes in some patients with BCBM.

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Figures

Fig. 1.
Fig. 1.
Kaplan Meier Curve for Survival by Era.
Fig. 2.
Fig. 2.
Kaplan Meier Curves for Survival by Breast GPA.
See this image and copyright information in PMC

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