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Central nervous system metastases in metastatic breast cancer: Incidence, subtype-specific patterns, and outcomes from the Austrian AGMT_MBC registry

The Breast·August 3Open Access
Obstetrics & GynecologyConfirms priorBrain MetastasesMetastatic Breast CancerTriple-Negative Breast CancerRegistry-Based Cohort StudyFocal RadiotherapyNeurosurgeryWhole Brain RadiotherapyAdult

Summary

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What was studied

Real-world incidence, subtype-specific risk, and outcomes of brain metastases (BM) in 2,775 metastatic breast cancer (MBC) patients from the Austrian AGMT_MBC registry, with a median follow-up of 77 months.

Key findings

17.2% of patients developed BM during the metastatic course. BM risk was highest in HR+/HER2+ (OR 4.43) and HR−/HER2+ (OR 3.57) subtypes vs. luminal MBC; TNBC had OR 2.91. BM were associated with markedly shorter OS (HR 4.23; p<0.001). TNBC had the worst OS after BM diagnosis (4.7 months). Brain-only disease conferred better OS than concurrent extracranial disease (HR 0.58; p=0.001). Focal radiotherapy or neurosurgery outperformed whole brain radiotherapy, which declined over time.

Study limitations

Registry-based design limits causal inference and may have incomplete treatment data. Receptor discordance data (HR loss 14.5%, HER2 gain 9.8%) may reflect biopsy sampling bias. The Austrian single-country cohort may limit generalizability to other healthcare settings.

Clinical implications

HER2+ and TNBC patients face the highest BM risk and shortest survival after BM—prioritize active CNS surveillance and enroll these patients in BM-specific trials. When BM are detected, focal radiotherapy or neurosurgery is associated with longer OS than whole brain radiotherapy.

Related Questions

Explore related topics

Which HER2-targeted therapies have CNS penetration in metastatic breast cancer?What is the role of stereotactic radiosurgery versus whole brain radiotherapy in breast cancer brain metastases?How does receptor discordance between primary and metastatic breast cancer affect treatment decisions?

Publication Details

Year
2026
Journal
The Breast
Sample Size
n=2,775
Source
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