Examination and prognostic implications of the unique microenvironment of breast cancer brain metastases.

Authors

null

Grace Prince

University of North Carolina, Chapel Hill, NC

Grace Prince , Allison Mary Deal , Megan Jean McKee , Dimitri G. Trembath , Kevin Keith , Juanita Ramirez , Bentley Randall Midkiff , Kimberly L. Blackwell , Jose Pablo Leone , Ronald L. Hamilton , Adam Brufsky , Aki Morikawa , Edi Brogi , Andrew David Seidman , Matthew G. Ewend , Lisa A. Carey , Stergios J. Moschos , Benjamin Garrett Vincent , Carey K. Anders

Organizations

University of North Carolina, Chapel Hill, NC, Atlanta Cancer Care, Decatur, GA, Duke University Medical Center, Durham, NC, University of Iowa, Iowa City, IA, University of Pittsburgh, Pittsburgh, PA, University of Michigan, Ann Arbor, MI, Memorial Sloan-Kettering Cancer Center, New York, NY, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC

Research Funding

NIH

Background: Brain metastases (BM) are an increasingly common consequence of breast cancer (BC). Knowledge of the microenvironment in primary BC and its impact on prognosis is evolving. A similar understanding of the microenvironment of BC metastases is lacking, particularly for the brain, where unique immune regulation governs stroma composition. Such features of the peri-tumoral landscape, i.e. high immune infiltrate and low hemorrhage, offer prognostic value in BM from melanoma. This study reports on 4 biomarkers, gliosis (glio), immune infiltrate (immune), hemorrhage (hem) and necrosis (nec), and their prognostic significance in BCBM. Methods: A biobank of 203 patients (pts) who underwent craniotomy between 1989-2013 was created across 4 sites. Glio, immune, and hem (grouped 0 v 1-3) and nec (0-2 v 3) were scored via H&E stain (0-3). Overall survival (OS (years)) from craniotomy was estimated using the Kaplan-Meier method; log-rank tests compared OS. Cox proportional hazards regression was used to evaluate prognostic value of the 4 biomarkers. Results: Mean age at primary BC diagnosis was 48 years (range 26-77). BCBM subtype (n = 158) was 36% HER2+, 26% HR+/HER2-, 38% HR-/HER2- (TN). Across all samples, expression was 82% glio, 45% immune, 82% hem, and 13% nec. Subtype differences were seen for nec (higher in TN, p < 0.01). Across all pts, expression of glio, immune, and hem was associated with improved OS (years): 1.08 v 0.62 (p = 0.03), 1.31 v 0.93 (p = 0.03), 1.07 v 0.92 (p = 0.1), respectively. Nec was associated with inferior OS: 0.38 v 1.12 (p = 0.01). The association with improved OS was maintained for glio in TN (p = 0.02), and immune (p = 0.001) and hem (p = 0.07) in HER2+. In a multivariable model for OS, adding the 4 biomarkers to traditional clinical variables (age, race, subtype) significantly improved the model fit (p < 0.001). Conclusions: Nec is a poor prognostic finding in BCBM across all subtypes. Glio confers superior prognosis in TN, while immune and hem correlate with superior prognosis in HER2+. A deeper understanding of the rich BCBM microenvironment both refines prognostic considerations for this pt population and may lead to future investigations of targeted immunotherapies in select subtypes of BCBM.

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Central Nervous System Tumors

Track

Central Nervous System Tumors

Sub Track

Brain Metastases

Citation

J Clin Oncol 35, 2017 (suppl; abstr 2072)

DOI

10.1200/JCO.2017.35.15_suppl.2072

Abstract #

2072

Poster Bd #

314

Abstract Disclosures

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