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. 2022 Feb;27(2):332-339.
doi: 10.1007/s10147-021-02049-w. Epub 2021 Oct 18.

HER2-low breast cancer could be associated with an increased risk of brain metastasis

Deniz Can Guven  1 , Mehmet Burak Kaya  2 , Burak Fedai  2 , Mucahit Ozden  2 , Hasan Cagri Yildirim  3 , Kemal Kosemehmetoglu  4 , Neyran Kertmen  3 , Omer Dizdar  3 , Aysegul Uner  4 , Sercan Aksoy  3
Affiliations

HER2-low breast cancer could be associated with an increased risk of brain metastasis

Deniz Can Guven et al. Int J Clin Oncol. 2022 Feb.

Abstract

Purpose: The HER2-low breast cancer is a newly recognized entity with the clinical characteristics is yet to be defined. We hypothesized that HER2-low breast cancer could lead to an increased rate of brain metastases in patients with localized breast cancer. We tested this hypothesis in a large cohort of breast cancer patients with long follow-up.

Methods: We included 2686 adult breast cancer patients followed up in Hacettepe University Cancer Center. Patients with 1 + positive HER2 expression and 2 + HER2 expression with a negative FISH were categorized as HER2-low disease. We evaluated the brain metastasis risk with binary logistic regression analyses and reported odds ratios (OR) with 95% confidence intervals (CI).

Results: During a median 95.4 (IQR 72.6-123.1) month follow-up, 184 patients developed brain metastasis (6.9%). The brain metastases were developed in 5.1% of the patients with HER2-negative disease, 8.5% of the patients with HER2-low disease, and 10.1% of the patients with HER2-positive disease. A multivariable binary logistic regression model demonstrated an increased risk of brain metastasis in patients with HER2-low disease (OR: 1.611, 95% CI 1.055-2.460, p = 0.027) and in HER2-positive patients (OR: 1.837, 95% CI 1.308-2.580, p < 0.001). Additionally, HR + -HER2-low disease was associated with a decreased DFS compared to HR + -HER2-negative disease (p = 0.008).

Conclusion: In this study, we observed an increased risk of brain metastasis in localized breast cancer patients with HER2-low disease. We think that a high level of vigilance and a low threshold for brain imaging could benefit HER2-low breast cancer patients similar to the patients with HER-positive disease.

Keywords: Brain metastasis; Breast cancer; HER2; HER2-low.

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