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Introduction  To evaluate the incidence of central nervous system (CNS) involvement in patients with breast cancer treated with a taxane-based chemotherapy regimen and to determine predictive factors for CNS relapse.    Methods  The medical files of patients with early breast cancer ( n  = 253) or advanced stage breast cancer ( n  = 239) as well of those with other solid tumors ( n  = 336) treated with or without a taxane-based chemotherapy regimen during a 42-month period were reviewed. HER2/neu overexpression was identified by immunohistochemistry, whereas cytokeratin 19 (CK-19) mRNA-positive circulating tumor cells (CTCs) in the peripheral blood were identified by real-time PCR.    Results  The incidence of CNS relapse was similar in patients suffering from breast cancer or other solid tumors (10.4% and 11.4%, respectively;  P  = 0.517). The incidence of CNS relapse was significantly higher in breast cancer patients with advanced disease ( P  = 0.041), visceral disease and bone disease ( P  = 0.036), in those who were treated with a taxane-containing regimen ( P  = 0.024), in those with HER2/neu-overexpressing tumors ( P  = 0.022) and, finally, in those with detectable CK-19 mRNA-positive CTCs ( P  = 0.008). Multivariate analysis revealed that the stage of disease (odds ratio, 0.23; 95% confidence interval, 0.007–0.23;  P  = 0.0001), the HER2/neu status (odds ratio, 29.4; 95% confidence interval, 7.51–101.21;  P  = 0.0001) and the presence of CK-19 mRNA-positive CTCs (odds ratio, 8.31; 95% confidence interval, 3.97–12.84;  P  = 0.001) were independent predictive factors for CNS relapse.    Conclusion  CNS relapses are common among breast cancer patients treated with a taxane-based chemotherapy regimen, patients with HER2/neu-positive tumor and patients with CK-19 mRNA-positive CTCs.

breast cancer research

Central nervous system relapse in patients with breast cancer is associated with advanced stages, with the presence of circulating occult tumor cells and with the HER2/neu status