Brain Metastases from Biliary Tract Cancer: Case Series and Clinicogenomic Analysis.
bile ducts
cholangiocarcinoma
extrahepatic
gallbladder
genomics
intrahepatic
mutation
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
06 04 2023
06 04 2023
Historique:
received:
23
07
2022
accepted:
17
11
2022
medline:
10
4
2023
pubmed:
31
1
2023
entrez:
30
1
2023
Statut:
ppublish
Résumé
Limited data from small series have suggested that brain metastases from biliary tract cancers (BrM-BTC) affect ≤2% of patients with BTC. We sought to review our experience with patients with BrM-BTC and to identify associations of tumor-related molecular alterations with outcomes. A retrospective review of patients with BTC seen at a tertiary referral center from 2005 to 2021 was performed; patients with BrM-BTC were identified, and clinical and molecular data were collected. Twenty-one of 823 patients with BTC (2.6%) developed BrM. For patients with BrM-BTC, median follow-up time was 27.9 months after primary BTC diagnosis and 3.1 months after BrM diagnosis. Median time from primary diagnosis to diagnosis of BrM was 14.4 [range, 1.1-66.0] months. Median overall survival (OS) from primary diagnosis was 31.5 [2.9-99.8] months and median OS from BrM diagnosis was 4.2 [0.2-33.8] months. Patients who underwent BrM-directed therapy trended toward longer OS following BrM diagnosis than patients receiving supportive care only (median 6.5 vs 0.8 months, P = .060). The BrM-BTC cohort was enriched for BRAF (30%), PIK3CA (25%), and GNAS (20%) mutations. patients with BrM-BTC with BRAF mutations trended toward longer OS following BrM diagnosis (median 13.1 vs 4.2 months, P = .131). This is the largest series of patients with BrM-BTC to date and provides molecular characterization of this rare subgroup of patients with BTC. Patients with BrM-BTC may be more likely to have BRAF mutations. With advances in targeted therapy for patients with BTC with actionable mutations, continued examination of shifting patterns of failure, with emphasis on BrM, is warranted.
Sections du résumé
BACKGROUND
Limited data from small series have suggested that brain metastases from biliary tract cancers (BrM-BTC) affect ≤2% of patients with BTC. We sought to review our experience with patients with BrM-BTC and to identify associations of tumor-related molecular alterations with outcomes.
MATERIALS AND METHODS
A retrospective review of patients with BTC seen at a tertiary referral center from 2005 to 2021 was performed; patients with BrM-BTC were identified, and clinical and molecular data were collected.
RESULTS
Twenty-one of 823 patients with BTC (2.6%) developed BrM. For patients with BrM-BTC, median follow-up time was 27.9 months after primary BTC diagnosis and 3.1 months after BrM diagnosis. Median time from primary diagnosis to diagnosis of BrM was 14.4 [range, 1.1-66.0] months. Median overall survival (OS) from primary diagnosis was 31.5 [2.9-99.8] months and median OS from BrM diagnosis was 4.2 [0.2-33.8] months. Patients who underwent BrM-directed therapy trended toward longer OS following BrM diagnosis than patients receiving supportive care only (median 6.5 vs 0.8 months, P = .060). The BrM-BTC cohort was enriched for BRAF (30%), PIK3CA (25%), and GNAS (20%) mutations. patients with BrM-BTC with BRAF mutations trended toward longer OS following BrM diagnosis (median 13.1 vs 4.2 months, P = .131).
CONCLUSION
This is the largest series of patients with BrM-BTC to date and provides molecular characterization of this rare subgroup of patients with BTC. Patients with BrM-BTC may be more likely to have BRAF mutations. With advances in targeted therapy for patients with BTC with actionable mutations, continued examination of shifting patterns of failure, with emphasis on BrM, is warranted.
Identifiants
pubmed: 36715178
pii: 7008897
doi: 10.1093/oncolo/oyac273
pmc: PMC10078902
doi:
Substances chimiques
Proto-Oncogene Proteins B-raf
EC 2.7.11.1
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
327-332Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : NIH HHS
ID : U54CA210181
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press.
Références
J Clin Oncol. 2022 Feb 10;40(5):492-516
pubmed: 34932393
Lancet. 2015 Aug 1;386(9992):444-51
pubmed: 26037941
Cancers (Basel). 2020 Jul 24;12(8):
pubmed: 32722188
Drugs. 2020 Jun;80(9):923-929
pubmed: 32472305
Lancet Oncol. 2018 May;19(5):603-615
pubmed: 29573941
Oncology. 2018;94(1):7-11
pubmed: 29024931
Cancer Manag Res. 2018 Dec 28;11:379-388
pubmed: 30643463
Cancer. 2020 Feb 1;126(3):523-530
pubmed: 31658370
N Engl J Med. 2012 Jul 12;367(2):107-14
pubmed: 22663011
Asian Pac J Cancer Prev. 2012;13(5):1995-7
pubmed: 22901160
Cancer Discov. 2017 Sep;7(9):943-962
pubmed: 28818953
J Gastrointest Oncol. 2022 Apr;13(2):822-832
pubmed: 35557587
Lancet Oncol. 2016 Sep;17(9):1248-60
pubmed: 27480103
Lancet Oncol. 2020 May;21(5):671-684
pubmed: 32203698
N Engl J Med. 2015 Jan 1;372(1):30-9
pubmed: 25399551
Clin Cancer Res. 2022 Jul 1;28(13):2733-2737
pubmed: 35259259
Oncologist. 2020 May;25(5):447-453
pubmed: 31694894
Lancet Oncol. 2020 Sep;21(9):1234-1243
pubmed: 32818466
Lancet. 2021 Jan 30;397(10272):428-444
pubmed: 33516341