2011 - The Presentation of Leptomeningeal Disease by Breast Cancer Subtype and Potential Implications for Surveillance Brain MRIs
Presenter(s)
J. Barranco1, R. Sarawagi2, C. Chiodo3, V. M. Khatri3, M. N. Mills3, R. Upadhyay2,4, D. E. Oliver5, Y. Pina4, P. Forsyth6, A. Soyano7, I. Washington3, R. Diaz3, H. H. M. Yu5, H. Soliman7, H. S. Han7, and K. A. Ahmed5; 1University of South Florida, Tampa, FL, 2H. Lee Moffitt Cancer and Research Institute, Tampa, FL, 3Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 4Moffitt Cancer Center, Tampa, FL, 5H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, 6H. Lee Moffitt Cancer Center and Research Institute, Department of Neuro-Oncology, Tampa, FL, 7H. Lee Moffitt Cancer Center and Research Institute, Department of Breast Oncology, Tampa, FL
Purpose/Objective(s): Leptomeningeal disease (LMD) is a known complication of advanced breast cancer with historically poor clinical outcomes. As systemic therapy improves, the prevalence of breast cancer LMD is increasing. Current National Comprehensive Cancer Network (NCCN) Guidelines do not recommend breast cancer brain MRI surveillance for breast cancer patients unless suspicious central nervous system (CNS) symptoms are present. We sought to characterize the clinical presentation and institutional outcomes of breast cancer patients with LMD at initial CNS diagnosis stratified by subtype.
Materials/Methods: Breast cancer patients diagnosed with LMD at our institution at initial diagnosis of CNS involvement between 2015 and 2025 were identified. Details of demographics, initial presentation, treatments delivered, and overall survival (OS) were assessed. Kruskal-Wallis and Pearson’s chi-square tests were used to test differences between subtypes. OS was calculated from date of LMD diagnosis using the Kaplan–Meier (KM) method with differences between groups assessed via the log-rank test.
Results: A total of 426 breast cancer patients were diagnosed with CNS metastases of which 93 (22%) presented with LMD. Breast cancer subtypes included 42 (45%) hormone receptor (HR)+/HER2-, 26 (28%) HER2+, and 25 (27%) triple negative (TN). The majority of patients were white (75%) and symptomatic (90%) with a median age at LMD diagnosis of 56 (range: 33-85). TN patients had the shortest interval between stage IV diagnosis to LMD diagnosis (TN: median 7.4 months, HER2+: 11.1 months, HR+/HER2-: 21.0 months, p=0.0003). TN patients were most likely to present without evidence of systemic metastases (TN: 40%, HER2+: 3.9%, HR+/HER2-: 4.8%, p=0.0002) and the least likely to have liver metastases (TN: 16%, HR+/HER2-: 50%, HER2+: 58%, p=0.005). The median lines of prior systemic therapy in the stage IV setting at LMD diagnosis were HER2+: 2, TN: 2, and HR+/HER2-: 4, p=0.04. Significant differences were noted in OS by subtype following LMD diagnosis with a 12 month OS of 64%, 17%, and 32% for HER2+, HR+/HER2- and TN subtypes, respectively (p=0.0004).
Conclusion: Our institutional analysis found significant differences in presentation of LMD by breast cancer subtype with TN patients presenting earlier in their diagnosis, more isolated LMD recurrences with the receipt of fewer prior systemic therapies. Significant differences were noted in OS by subtype. Earlier brain MRI surveillance may benefit patients with aggressive subtypes such as TN breast cancer.