NOTQ-03 NEUROLOGICAL SYMPTOMS AND CLINICAL OUTCOMES IN PATIENTS WITH CENTRAL NERVOUS SYSTEM METASTASIS FROM BREAST CANCER

Abstract

Breast cancer brain metastases (BCBM) and CNS disease lead to significant neurological debility, affecting patient and caregiver quality of life. While trials analyze concrete outcomes based on tumor burden, data is limited on whether modern treatments for BCBM and leptomeningeal disease (LMD) improve patient morbidity. This study examined patients diagnosed with symptomatic CNS disease and assessed whether current therapies improved neurological symptoms. Retrospective chart review was performed on patients seen at a single academic institution diagnosed with CNS disease from breast cancer from 1/1/2020 to 9/1/2024. The cohort included 47 patients (31 HR-positive, seven Her2-positive, and 13 TNBC). 35 of 47 patients had stage IV disease at presentation, with 30 patients having two or fewer brain metastases on MRI. 57.6% of primary brain metastases measured <2 cm and 84.9% measured <4 cm. Eight patients had LMD, of which three had concurrent BCBM. Gait dysfunction (n = 14; 33.3%), extremity weakness, (n = 13; 30.9%), and headaches (n = 12; 28.6%) were the most common neurological symptoms, with a third of patients exhibiting two or more and 42.9% exhibiting three or more symptoms. Median observation time for study cohort was 286 days, during which 19 patients died, with median time from diagnosis of CNS disease to death of 125 days. Thirteen patients (27.7%) had surgical resection, 15 (31.9%) underwent SRS, and 10 (21.2%) received WBRT; 17 received multimodal locoregional treatment. 33 patients received systemic pharmacotherapy, most commonly CDK 4/6 inhibitors with aromatase inhibitors. Of patients who received systemic pharmacotherapy (+/- surgery and XRT), 14 (56.0%) were symptomatic after two months. Six of nine symptomatic patients treated with surgery and SRS, seven of eight treated with WBRT, and four of seven patients treated with radiation for isolated LMD remained symptomatic after treatment. Prospective studies are needed to better understand how neurological comorbidities affect patient QoL, functional status, and mortality.