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Frequency and outcomes of brain metastases in patients with HER2 ‐mutant lung cancers
Author(s) -
Offin Michael,
Feldman Daniel,
Ni Ai,
Myers Mackenzie L.,
Lai W. Victoria,
Pentsova Elena,
Boire Adrienne,
Daras Mariza,
Jordan Emmet J.,
Solit David B.,
Arcila Maria E.,
Jones David R.,
Isbell James M.,
Beal Kathryn,
Young Robert J.,
Rudin Charles M.,
Riely Gregory J.,
Drilon Alexander,
Tabar Viviane,
DeAngelis Lisa M.,
Yu Helena A.,
Kris Mark G.,
Li Bob T.
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32461
Subject(s) - kras , medicine , epidermal growth factor receptor , hazard ratio , oncology , lung , lung cancer , brain metastasis , mutant , cancer , cancer research , metastasis , confidence interval , colorectal cancer , biology , gene , biochemistry
Background Mutations in human epidermal growth factor receptor 2 ( HER2 ; also known as ERBB2 ) are found in approximately 2% of lung adenocarcinomas. The frequency and clinical course of brain metastases in this oncogenic subset are ill defined. Methods Baseline and subsequent development of brain metastases was evaluated in consecutive patients with HER2 ‐mutant (n = 98), epidermal growth factor receptor ( EGFR )–mutant (n = 200), and KRAS ‐mutant lung cancers (n = 200). Results At metastatic diagnosis, the odds ratio (ORs) for brain metastases was similar for patients whose tumors harbored HER2 mutations (19%) in comparison with patients with KRAS mutations (24%; OR for HER2 vs KRAS , 0.7; P = .33) but lower compared to patients with EGFR mutations (31%; OR for HER2 vs EGFR , 0.5; P = .03). Patients with lung cancer and HER2 mutations developed more brain metastases on treatment than patients with KRAS mutations (28% vs 8%; hazard ratio [HR], 5.2; P < .001) and trended more than patients with EGFR mutations (28% vs 16%; HR, 1.7; P = .06). Patients with HER2 YVMA mutations also developed more brain metastases on treatment than patients with KRAS mutations (HR, 5.9; P < .001). The median overall survival (OS) was shorter for patients with HER2 ‐mutant (1.6 years; P < .001) or KRAS ‐mutant lung cancers (1.1 years; P < .001) than patients with EGFR ‐mutant lung cancers (3.0 years). Brain metastases occurred in 47% of patients with HER2 ‐mutant lung cancers, which imparted shorter OS (HR, 2.7; P < .001). Conclusions These data provide a framework for brain imaging surveillance in patients with HER2 ‐mutant lung cancers and underpin the need to develop HER2‐targeted agents with central nervous system activity.