Journal
CANCER
Volume 113, Issue 10, Pages 2638-2645Publisher
WILEY
DOI: 10.1002/cncr.23930
Keywords
triple-negative breast cancer; basal-like breast cancer; brain metastases; survival; central nervous system recurrence
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Funding
- Breast Cancer Research Foundation
- Hurricane Voices Junior Faculty Award
- American Society of Clinical Oncology Career Development Award
- Karen Webster and David Evans Research Fund
- National Cancer Institute Specialized Program in Research Excellence in Breast Cancer at DF/HCC [CA89393]
- Susan G. Komen Breast Cancer Foundation
- NIH [R01-CA81393]
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BACKGROUND. The purpose of the current study was to characterize the Outcomes of patients with metastatic triple-negative breast cancers, including the risk and clinical consequences of central nervous system (CNS) recurrence. METHODS. Using pharmacy and pathology records, a study group of 116 patients who were treated for metastatic triple-negative breast cancer at Dana-Farber Cancer Institute between January 2000 and June 2006 was identified. RESULTS. The median survival front time of metastatic diagnosis was 13.3 months. Sixteen patients (14%) were diagnosed with CNS involvement at the time of initial metastatic diagnosis; overall, 46% of patients were diagnosed with CNS metastases before death. The median survival after a diagnosis of CNS metastasis was 4.9 months. The age-adjusted and race-adjusted rate of death for patients whose first presentation included a CNS metastasis was 3.4 times (95% confidence interval, 1.9-6.1 times) that of patients without a CNS lesion at the time of first metastatic presentation. Of the 53 patients who developed brain metastases, only 3 patients were judged to have stable or responsive systemic disease in the face of progressive CNS disease at the last follow-up before death. CONCLUSIONS. Triple-negative breast cancer is associated with poor survival after recurrence. CNS recurrence is common, but death as a direct consequence of CNS progression in the setting of controlled systemic disease is uncommon. Thus, it does not appear that the high rate of CNS involvement is because of a sanctuary effect, but rather is due to the lack of effective therapies in general for this aggressive subtype of breast cancer. New treatment strategies are needed. Cancer 2008; 113:2638-45. (C) 2008 American Cancer Society.
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