Dr Huppert on Survival Outcomes of Patients With Metastatic Breast Cancer and Leptomeningeal Disease

“We saw a doubling [of OS] in the triple-negative cohort, which likely reflected both improvements in systemic therapies in general and improvements in CNS-penetrant therapies. Unfortunately, in the HR-positive group, we didn’t see quite the same improvement. This remains an area of unmet clinical need.”

Laura A. Huppert, MD, breast medical oncologist, assistant professor, University of California, San Francisco School of Medicine, discusses survival outcomes of patients with metastatic breast cancer and leptomeningeal disease according to disease subtype and other clinical characteristics.

In a single-center, retrospective cohort study spanning the years 2000 to 2024, investigators examined clinical, treatment, and survival data for patients with metastatic breast cancer and leptomeningeal disease, focusing on differences between cohorts diagnosed from 2000 to 2014 and 2015 to 2024.

According to results presented at the 2024 San Antonio Breast Cancer Symposium, patients diagnosed with leptomeningeal disease between 2015 and 2024 lived longer compared with those diagnosed between 2000 and 2014, although their median overall survival (OS) remained limited. Among the subtypes, patients with triple-negative breast cancer (TNBC) and leptomeningeal disease exhibited the shortest OS. The median OS from the time of brain metastases diagnosis to death varied significantly by subtype: 30.9 months in the HER2-positive cohort; 19.6 months in the hormone receptor (HR)–positive, HER2-negative cohort (P < .01); and 13.3 months in the TNBC cohort (P < .01).

Comparing the earlier cohort (2000-2014) with the more recent cohort (2015-2024), significant improvements were observed in the HER2-positive and TNBC groups. The median OS in the HER2-positive cohort increased from26.5 months to 41.2 months (P = .009), whereas the median OS in the TNBC cohort doubled from 8.8 months to 16.2 months (P = .04). These gains likely reflect advances in systemic therapies and central nervous system (CNS)–penetrant agents, according to Huppert. Conversely, the HR-positive, HER2-negative cohort had only a modest increase in median OS, from 18.2 months to 20.4 months, which was not statistically significant (P = .89), she concludes.