Originally published as JCO Early Release 10.1200/JCO.2006.07.0250 on November 13 2006

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Prognostic Significance of Human Epidermal Growth Factor Receptor Positivity for the Development of Brain Metastasis After Newly Diagnosed Breast Cancer

Zsolt Gabos, Richie Sinha, John Hanson, Nitin Chauhan, Judith Hugh, John R. Mackey, Bassam Abdulkarim

From the Department of Oncology, Cross Cancer Institute and University of Alberta; and the Departments of Radiation Oncology, Statistics and Epidemiology, Laboratory Medicine and Pathology, and Medical Oncology, University of Alberta, Edmonton, Alberta, Canada

Address reprint requests to Bassam Abdulkarim, MD, PhD, Department of Oncology & Experimental Oncology, Cross Cancer Institute & University of Alberta, 11560 University Avenue, Edmonton, AB, Canada T6G 1Z2; e-mail: bassamab{at}cancerboard.ab.ca

PURPOSE: As survival in breast cancer patients is improving, brain metastases are becoming increasingly prevalent. The risk of brain metastases in newly diagnosed human epidermal growth factor receptor 2 (HER-2) –overexpressing breast cancer patients is not yet fully defined. We aimed to analyze the risk of brain metastasis in newly diagnosed HER-2–positive breast cancer patients in comparison with HER-2–negative patients.

PATIENTS AND METHODS: To determine the incidence of brain metastases in HER-2–overexpressing patients, we analyzed a cohort of newly diagnosed 301 HER-2–positive and 363 HER-2–negative patients identified between January 1998 and December 2003. The association between histologic features and the occurrence of brain metastases was evaluated with univariate and multivariate Cox regression analysis.

RESULTS: Median follow-up was 3.9 years. Brain metastases were identified in 9% (27 patients) with HER-2–overexpressing breast cancer compared with only 1.9% (7 patients) in the HER-2 negative patients (hazard ratio 4.23 [1.84-9.74], P = .0007). HER-2 overexpression, tumor size larger than 2 cm, at least one positive node, and grade 2/3 disease were predictors of brain metastases in univariate analysis. In multivariate analysis, HER-2 overexpression, tumor size larger than 2 cm, and hormone-receptor negativity were independent prognostic factors for the development of brain metastases, whereas hormone-receptor expression was protective.

CONCLUSION: Our study shows that newly diagnosed HER-2–overexpressing breast cancer patients are at increased risk for brain metastases. Because most brain metastases occur after the development of systemic disease, these findings prompt consideration of brain prophylaxis strategies with HER-2–inhibiting small molecules able to cross the blood-brain barrier and/or radiologic screening to detect asymptomatic brain metastases.

published online ahead of print at www.jco.org on November 13, 2006.

Z.G. and R.S. contributed equally to this work.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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