Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Aug 28;21(1):967.
doi: 10.1186/s12885-021-08708-5.

Prognostic factors of brain metastasis and survival among HER2-positive metastatic breast cancer patients: a systematic literature review

Michelle D Hackshaw  1 , Heather E Danysh  2 , Mackenzie Henderson  3 , Eric Wang  3   4 , Nora Tu  3 , Zahidul Islam  3 , Amy Ladner  5 , Mary E Ritchey  5 , Maribel Salas  6   7
Affiliations
Review

Prognostic factors of brain metastasis and survival among HER2-positive metastatic breast cancer patients: a systematic literature review

Michelle D Hackshaw et al. BMC Cancer. .

Abstract

Background: Patients with breast cancer who overexpress the human epidermal growth factor receptor 2 (HER2) and subsequently develop brain metastasis (BM) typically experience poor quality of life and low survival. We conducted a comprehensive literature review to identify prognostic factors for BM and predictors of survival after developing BM, and the effects of therapies with different mechanisms of action among patients with HER2+ breast cancer (BC).

Methods: A prespecified search strategy was used to identify research studies investigating BM in patients with HER2+ BC published in English during January 1, 2009-to June 25, 2021. Articles were screened using a two-phase process, and data from selected articles were extracted.

Results: We identified 25 published articles including 4097 patients with HER2+ BC and BM. Prognostic factors associated with shorter time to BM diagnosis after initial BC diagnosis included younger age, hormone receptor negative status, larger tumor size or higher tumor grade, and lack of treatment with anti-HER2 therapy. Factors predictive of longer survival after BM included having fewer brain lesions (< 3 or a single lesion) and receipt of any treatment after BM, including radiosurgery, neurosurgery and/or systemic therapy. Patients receiving combination trastuzumab and lapatinib therapy or trastuzumab and pertuzumab therapy had the longest median survival compared with other therapies assessed in this review.

Conclusions: More research is needed to better understand risk factors for BM and survival after BM in the context of HER2+ BC, as well as the assessment of new anti-HER2 therapy regimens that may provide additional therapeutic options for BM in these patients.

Keywords: Anti-HER2 therapy; Brain metastasis; HER2-positive; HER2 +; Prognostic factors; Survival.

PubMed Disclaimer

Conflict of interest statement

MS, MDH, MH, NT, and ZI are Daiichi Sankyo, Inc. employees. EW is an employee of Rutgers University and is contracted to Daiichi Sankyo, Inc. HED, AL, and MER are employees of RTI Health Solutions, an independent nonprofit research organization that performs contracted project work for medical device and pharmaceutical companies.

Figures

Fig. 1
Fig. 1
PRISMA Diagram. aThis includes one additional article identified from the review of the bibliography of a systematic review/meta-analysis after initial record screening, hence there appears to be one extra article in this diagram; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

References

    1. Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LAG, et al. US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst. 2014;106(5). 10.1093/jnci/dju055. - PMC - PubMed
    1. Goddard KA, Weinmann S, Richert-Boe K, Chen C, Bulkley J, Wax C. HER2 evaluation and its impact on breast cancer treatment decisions. Public Health Genomics. 2012;15(1):1–10. doi: 10.1159/000325746. - DOI - PMC - PubMed
    1. Leone JP, Lin NU. Systemic therapy of central nervous system metastases of breast cancer. Curr Oncol Rep. 2019;21(6):49. doi: 10.1007/s11912-019-0802-6. - DOI - PubMed
    1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): breast Cancer. 2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed: 1 Jul 2019.
    1. Ramakrishna N, Temin S, Lin NU. Recommendations on disease management for patients with advanced human epidermal growth factor receptor 2-positive breast cancer and brain metastases: ASCO clinical practice guideline update summary. J Oncol Pract. 2018;14(8):505–507. doi: 10.1200/JOP.18.00291. - DOI - PubMed