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. 2025 Jan;209(2):303-314.
doi: 10.1007/s10549-024-07493-6. Epub 2024 Oct 5.

Intracranial outcomes following neurosurgical resection in patients with brain metastases secondary to HER2-positive breast cancer versus other subtypes

Narmeen S Rashid  1 , Nayan Lamba  2   3 , Paul J Catalano  4   5 , Wenya Linda Bi  6 , Omar Arnaout  6 , Shyam K Tanguturi  3 , Rifaquat Rahman  3 , Daphne A Haas-Kogan  3 , Nancy U Lin  7 , Patrick Y Wen  1   8 , Ayal A Aizer  9
Affiliations

Intracranial outcomes following neurosurgical resection in patients with brain metastases secondary to HER2-positive breast cancer versus other subtypes

Narmeen S Rashid et al. Breast Cancer Res Treat. 2025 Jan.

Abstract

Purpose: Neurosurgical resection serves an important role in select patients with breast cancer and brain metastases but can delay systemic therapy and yield complications. Consequently, identification of patients most likely to benefit from surgery is important. Given the poorer long-term intracranial responses to radiotherapy sometimes observed in HER2-positive (HER2 +) patients, we investigated whether neurosurgical resection is differentially beneficial in this population.

Methods: We identified 633 patients with newly diagnosed brain metastases arising from breast cancer managed at Brigham and Women's Hospital/Dana-Farber Cancer Institute between 2010 and 2022. Patients were stratified by breast cancer subtype: HER2 + (N = 189), hormone receptor positive (HR +)/HER2- (N = 267), and triple negative (N = 177). Per-patient and per-metastasis outcomes were evaluated; interaction models assessing the impact of neurosurgical resection by subtype were constructed.

Results: Relative to HR + /HER2- subtype, omission of upfront neurosurgical resection in patients with HER2 + disease was associated with increased subsequent utilization of salvage stereotactic radiation, whole brain radiotherapy, and craniotomy (interaction HR 2.02 [95% CI, 1.04-3.93], p = 0.04; HR 3.92 [95% CI, 1.24-12.40], p = 0.02; HR 4.98 [95% CI, 1.34-18.58], p = 0.02, respectively). Tumors stemming from HER2 + versus HR + /HER2- primaries displayed increased local recurrence when upfront neurosurgical resection was omitted (interaction HR 3.62 [95% CI, 1.06-12.38], p = 0.04). No such associations were noted when comparing triple negative to HR + /HER2- subtype (p-interaction > 0.05 in all cases).

Conclusion: Patients with HER2 + disease and brain metastases may disproportionately benefit from upfront neurosurgical resection relative to other subtypes. If validated, our results may suggest a lower threshold to consider surgery in brain metastases secondary to HER2 + breast cancer.

Keywords: Brain metastases; Breast cancer; HER2; Radiation; Recurrence; Surgery.

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Conflict of interest statement

Declarations. Competing Interests: Rifaquat Rahman reports consulting fees from Servier Pharmaceuticals and Telix Pharmaceuticals. Patrick Y. Wen reports research support from Astra Zeneca, Black Diamond, Bristol Meyers Squibb, Chimerix, Eli Lily, Erasca, Global Coalition For Adaptive Research, Kazia, MediciNova, Merck, Novartis, Quadriga, Servier, and VBI Vaccines and advisory board/consulting activities for Anheart, Astra Zeneca, Black Diamond, Celularity, Chimerix, Day One Bio, Genenta, Glaxo Smith Kline, Kintara, Merck, Mundipharma, Novartis, Novocure, Prelude Therapeutics, Sagimet, Sapience, Servier, Symbio, Tango, Telix, VBI Vaccines. Ayal A. Aizer reports research funding from Varian and NH TheraAguix and consulting for Novartis and Seagen. All other authors report no relevant financial or non-financial interests. Ethical approval: The institutional review board at our institution approved this study. Consent to participate: A waiver of informed consent was obtained for this study. Consent to publication: A waiver of informed consent was obtained for this study.

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References

    1. Lamba N, Wen PY, Aizer AA (2021) Epidemiology of brain metastases and leptomeningeal disease. Neuro Oncol 23:1447–1456. https://doi.org/10.1093/neuonc/noab101 - DOI - PubMed - PMC
    1. Nayak L, Lee EQ, Wen PY (2012) Epidemiology of brain metastases. Curr Oncol Rep 14:48–54. https://doi.org/10.1007/s11912-011-0203-y - DOI - PubMed
    1. Kuksis M, Gao Y, Tran W, Hoey C, Kiss A, Komorowski AS, Dhaliwal AJ, Sahgal A, Das S, Chan KK, Jerzak KJ (2021) The incidence of brain metastases among patients with metastatic breast cancer: a systematic review and meta-analysis. Neuro Oncol 23:894–904. https://doi.org/10.1093/neuonc/noaa285 - DOI - PubMed
    1. Aizer AA, Lamba N, Ahluwalia MS, Aldape K, Boire A, Brastianos PK, Brown PD, Camidge DR, Chiang VL, Davies MA, Hu LS, Huang RY, Kaufmann T, Kumthekar P, Lam K, Lee EQ, Lin NU, Mehta M, Parsons M, Reardon DA, Sheehan J, Soffietti R, Tawbi H, Weller M, Wen PY (2022) Brain metastases: a Society for Neuro-Oncology (SNO) consensus review on current management and future directions. Neuro Oncol 24:1613–1646. https://doi.org/10.1093/neuonc/noac118 - DOI - PubMed - PMC
    1. Corti C, Antonarelli G, Criscitiello C, Lin NU, Carey LA, Cortes J, Poortmans P, Curigliano G (2022) Targeting brain metastases in breast cancer. Cancer Treat Rev 103:102324. https://doi.org/10.1016/j.ctrv.2021.102324 - DOI - PubMed

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