It comprises three prog nostic classes based on Karnofsky performance status, age, and control of extracerebral disease. In this classification, the best survival, with AZD9291 a median of 7. 1 months, was observed in patients younger than 65 years of age with a KPS of at least 70, a con trolled primary tumor, and metastases restricted to the brain. The worst survival, with a median of 2. 3 months, was seen in patients with a KPS below 70. The remaining patients had a median survival of 4. 2 months. Several other prognostic scores for patients with brain metastases from different pri maries were subsequently developed, but none of them include molecular features or breast cancer spe cific parameters such as tumor HER 2 overexpression, nor specific treatments.

Several groups have published retrospective studies describing improved survival from time of BM diagnosis in BM patients with HER2 positive BC treated with tras Inhibitors,Modulators,Libraries tuzumab, compared with HER2 negative breast cancers. In a retrospective study including 56 patients with HER2 positive BC who developed BM, Nam and colleagues reported a median OS of 13 months in 21 patients who received trastuzumab after diagnosis of mCNS disease compared with 4 months in those who did not receive trastuzumab after diagnosis and 3 months in 70 BM patients with HER2 negative tumors. Bartsch and colleagues Inhibitors,Modulators,Libraries also analyzed Inhibitors,Modulators,Libraries the effect of the continuation of trastuzumab after diag nosis of BM for 17 patients, in comparison with a cohort of 36 pts with HER2 overexpressing tumors not treated with trastuzumab after WBRT.

In this report, KPS and trastuzumab were associated with better overall survival, with a trend towards longer time to in brain progression. Our results confirm the fact that tras tuzumab treated HER2 positive breast cancer patients Inhibitors,Modulators,Libraries with BM fare better than HER2 negative breast cancer patients and patients with HER2 positive tumors who do not receive trastuzumab. In agreement with three previous reports, this survival advantage for patients with brain metastases from tumors that overex press HER2 does not seem to be due to an intrinsic bio logic advantage of HER2 overexpression, as patients with HER2 overexpressing tumors who did not receive trastuzumab had survival similar to that of patients with tumors that did not overexpress Inhibitors,Modulators,Libraries HER2. In our experience, about 60% of HER 2 positive patients treated with trastuzumab who died apparently suc cumbed from CNS progression.

Similarly, in a retro spective series of 122 patients treated with trastuzumab between 1998 and 2000 at Dana Farber Partners Cancer Care, about 50% of the 21 patients with brain metastases who died apparently succumbed from CNS progression, despite stable or responsive non CNS disease. selleck products These results suggest that HER2 targeting may improve brain metastasis outcomes through durable control of systemic extracranial disease in HER2 positive breast cancer patients.