March 2021: Predicting prognosis of breast cancer patients with brain metastases

The incidence of brain metastases from breast cancer is increasing and the treatment is still a major challenge. Several scores have been developed in order to estimate the prognosis of patients with brain metastases by objective criteria. The aim of this study was to validate all three available graded-prognostic-assessment (GPA)-scores: original GPA, the breast-GPA and the updated breast-GPA in a cohort of 882 breast cancer patients with brain metastases from the Brain Metastases in the German Breast Cancer (BMBC) registry. The median age at diagnosis of brain metastases was 57 years, 22.3% of patients (n=197) had triple-negative, 33.4% (n=295) luminal A like, 25.1% (n=221) luminal B/HER2-enriched like and 19.2% (n=169) HER2-positive like breast cancer. The median overall survival (OS) in the cohort was 8.7 months. All three GPA-scores were associated with OS. Age ≥60 years, evidence of extracranial metastases, higher number of brain metastases, triple-negative subtype and low Karnofsky-Performance-Status were all associated with worse OS in univariate analysis (p< 0.001 each). The breast-GPA showed the highest probability of classifying patients with survival above 12 months in the best prognostic group (specificity 68.7% compared with 48.1% for the updated breast-GPA and 21.8% for the original GPA). Sensitivities for predicting 3 months survival were very low for all scores. In this analysis, all GPA-scores showed only moderate diagnostic accuracy in predicting the OS of BC patients with brain metastases. This analysis is of clinical relevance in the context of potential trials examining the benefit of early detection and treatment of brain metastases.

Riecke K, Müller V, Weide R, et al. Predicting Prognosis of Breast Cancer Patients with Brain Metastases in the BMBC Registry-Comparison of Three Different GPA Prognostic Scores. Cancers (Basel). 2021 Feb 17;13(4):844.

• PubMed Link