Single-center phase 2 trial of brain MRI surveillance among asymptomatic patients with stage IV breast cancer

Brain MRI screening of neurologically asymptomatic stage IV breast cancer (BC) patients is not recommended by NCCN guidelines, so that the incidence of asymptomatic brain metastasis among these patients is not well documented. A phase 2 trial at Moffitt Cancer Center (Tampa, FL) included 101 neurologically asymptomatic patients (40 HR+/HER2-, 33 HER2+, 28 TN) with stage IV BC, ECOG performance status ≤ 2, and life expectancy ≥ 6 months. Brain MRI detected brain metastasis in 14% of patients (18%, 15%, and 10% in TN, HER2+, and HR+/HER2-, respectively). Among patients without baseline brain metastasis, a second brain MRI after 6 months detected brain metastasis in 25% in TN, 24% in HER2+, and 23% in HR+/HER2- patients. The authors conclude that brain MRI surveillance among neurologically asymptomatic stage IV BC patients detects a substantial frequency of brain metastases.