Navigating breast cancer brain metastasis: Risk factors, prognostic indicators, and treatment perspectives

Abstract

In this editorial, we comment on the article by Chen et al. We specifically focus on the risk factors, prognostic factors, and management of brain metastasis (BM) in breast cancer (BC). BC is the second most common cancer to have BM after lung cancer. Independent risk factors for BM in BC are: HER-2 positive BC, triple-negative BC, and germline BRCA mutation. Other factors associated with BM are lung metastasis, age less than 40 years, and African and American ancestry. Even though risk factors associated with BM in BC are elucidated, there is a lack of data on predictive models for BM in BC. Few studies have been made to formulate predictive models or nomograms to address this issue, where age, grade of tumor, HER-2 receptor status, and number of metastatic sites (1 vs > 1) were predictive of BM in metastatic BC. However, none have been used in clinical practice. National Comprehensive Cancer Network recommends screening of BM in advanced BC only when the patient is symptomatic or suspicious of central nervous system symptoms; routine screening for BM in BC is not recommended in the guidelines. BM decreases the quality of life and will have a significant psychological impact. Further studies are required for designing validated nomograms or predictive models for BM in BC; these models can be used in the future to develop treatment approaches to prevent BM, which improves the quality of life and overall survival.

Keywords: Breast cancer; Brain metastasis; HER2 positive; Metastatic breast cancer; Risk factors, Predictive models

Core Tip: Breast cancer brain metastasis management faces many challenges. Key risk factors include HER-2 positivity, triple-negative subtype, and germline BRCA mutation. Limited predictive models emphasize the need for validated nomograms. Current guidelines recommend screening when symptomatic. Chen et al highlight HER-2 and triple-negative associations, impacting treatment strategies. Proactive research is crucial for preventive strategies, blood-brain barrier-penetrating therapies, and validated predictive models.