Ventriculoperitoneal Shunt for CNS Metastasis in Breast Cancer: Clinical Outcomes Based on Intrinsic Subtype

We show the real-world outcomes of patients with metastatic breast cancer who received a ventriculoperitoneal shunt (VPS) owing to central nervous system metastasis. More than one-half of the patients received a VPS for uncontrolled intracranial pressure (57.1%) and headache (55.7%), and most (77.1%) of these patients improved after VPS. During 36 months of median follow-up, the median overall survival after central nervous system metastasis and after VPS was 7.6 and 2.3 months, respectively. Background: Leptomeningeal metastasis (LM) is associated with a grave prognosis in breast cancer (BC) and can be controlled with a ventriculoperitoneal shunt (VPS). Information regarding LM and VPS based on intrinsic subtype is limited; thus, we investigated the clinical outcomes of BC treated with VPS. Patients and Methods: The present retrospective study comprised 70 patients diagnosed with LM who received a VPS. The patients were divided into 4 groups based on BC subtype: hormone receptor (HR)thorn/human epidermal growth factor receptor 2 (HER2)(-), HR+/HER2(+), HR-/HER2(+), and triple negative BC (TNBC). Results: The most common indications for VPS were uncontrolled intracranial pressure (57.1%) and uncontrolled headache (55.7%), which improved in 54 (77.1%) of 70 patients after VPS. The median overall survival (OS) after brain or LM and overall survival after VPS were 7.6 and 2.3 months, respectively. Anti-HER2 treatment was a significant prognostic factor for better OS after brain or LM based on multivariate analysis (hazard ratio, 0.15; 95% confidence interval, 0.04-0.57; P = .005), whereas TNBC was correlated with shorter OS after central nervous system metastasis (hazard ratio, 2.82; 95% confidence interval, 1.46-5.48; P = .002). Conclusions: There were significant differences in clinical outcome based on the intrinsic subtype of patients with BC with LM who received a VPS. Anti-HER2 treatment in patients with HER2(+) BC was associated with better survival in patients with metastatic BC with VPS insertion compared with those without. Survival of metastatic BC with VPS remained poor, especially in the TNBC subgroup. (C) 2021 The Author(s). Published by Elsevier Inc.

Automated summary

Patients with metastatic breast cancer and leptomeningeal metastasis who received ventriculoperitoneal shunt treatment showed improved symptoms and significant differences in survival time, with anti-HER2 treatment associated with better outcomes.