Clinical cancer research : an official journal of the American Association for Cancer Research · 2026
Proactive Brain Screening Using Contrast-Enhanced Brain CT Scans in HER2+ Metastatic Breast Cancer.
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Griguolo Gaia, Bottosso Michele, Landa Giusy, Bonomi Giorgio, Miglietta Federica, Guarascio Maria Cristina, La Commare Marina, Zanghì Francesca, Sheppard Terlisa, Giorgi Carlo Alberto, Falci Cristina, Hodgdon Christine, Caumo Francesca, Dieci Maria Vittoria, Guarneri Valentina
Аннотация
PURPOSE: According to recent EANO-ESMO guidelines, proactive brain imaging can be considered in asymptomatic patients with HER2+ metastatic breast cancer (mBC) because of high risk of developing brain metastases. However, optimal imaging modality and timing remain unclear. We retrospectively assessed the impact of contrast-enhanced CT screening on symptomatic brain metastases in patients with HER2+ mBC.
EXPERIMENTAL DESIGN: Consecutive patients newly diagnosed with HER2+ mBC treated with trastuzumab-pertuzumab plus taxane (2014-2024) were retrospectively identified. Brain screening was defined as at least one contrast-enhanced brain CT scan per year without neurologic symptoms during the first 2 years after diagnosis.
RESULTS: Among 148 identified patients, 73 underwent brain screening and 75 did not. The median number of annual brain CT scans during the first 2 years was 2.0 (IQR, 1.2-2.5) and 0.0 (IQR, 0-0.5) in the screening and nonscreening groups, respectively. Thirty (20.3%) patients developed brain metastases during the first 2 years. The cumulative brain metastasis incidence was significantly higher in patients undergoing screening (30.6% vs. 12.3%, Gray's P = 0.004), but symptomatic brain metastases were significantly lower in patients undergoing screening (0% vs. 9.5%, Gray's P = 0.012). Patients undergoing screening had better preserved performance status at brain metastasis diagnosis (P = 0.002) and a numerical trend toward fewer brain metastases (P = 0.057). Treatment patterns after brain metastasis diagnosis were similar, although whole-brain radiotherapy was used less often in the screening group (14.3% vs. 44.4%, P = 0.073).
CONCLUSIONS: Brain screening with CT scans was associated with fewer symptomatic brain metastases and better performance status at brain metastasis diagnosis, supporting proactive imaging in HER2+ mBC. Prospective studies are warranted to define optimal timing and imaging modalities.
EXPERIMENTAL DESIGN: Consecutive patients newly diagnosed with HER2+ mBC treated with trastuzumab-pertuzumab plus taxane (2014-2024) were retrospectively identified. Brain screening was defined as at least one contrast-enhanced brain CT scan per year without neurologic symptoms during the first 2 years after diagnosis.
RESULTS: Among 148 identified patients, 73 underwent brain screening and 75 did not. The median number of annual brain CT scans during the first 2 years was 2.0 (IQR, 1.2-2.5) and 0.0 (IQR, 0-0.5) in the screening and nonscreening groups, respectively. Thirty (20.3%) patients developed brain metastases during the first 2 years. The cumulative brain metastasis incidence was significantly higher in patients undergoing screening (30.6% vs. 12.3%, Gray's P = 0.004), but symptomatic brain metastases were significantly lower in patients undergoing screening (0% vs. 9.5%, Gray's P = 0.012). Patients undergoing screening had better preserved performance status at brain metastasis diagnosis (P = 0.002) and a numerical trend toward fewer brain metastases (P = 0.057). Treatment patterns after brain metastasis diagnosis were similar, although whole-brain radiotherapy was used less often in the screening group (14.3% vs. 44.4%, P = 0.073).
CONCLUSIONS: Brain screening with CT scans was associated with fewer symptomatic brain metastases and better performance status at brain metastasis diagnosis, supporting proactive imaging in HER2+ mBC. Prospective studies are warranted to define optimal timing and imaging modalities.