Local and systemic treatment for HER2-positive breast cancer with brain metastases: a comprehensive review

Abstract

The management of human epidermal growth factor receptor (HER2)-positive breast cancer has improved over the past decade. However, despite improvements in systemic control, a substantial proportion of patients with advanced HER2-positive breast cancer suffer from central nervous system metastases and even intracranial progression after aggressive local treatment. There is paucity of data and no consensus on the systemic therapies for patients with intracranial progression. This review discusses both local and systemic treatments for HER2-positive breast cancer with brain metastases with a special focus on the response of central nervous system metastases. A recommended practical treatment algorithm to guide physicians in selecting the most appropriate anti-HER2 therapy for their patients is suggested.

Leptomeningeal Carcinomatosis Secondary to Adenocarcinoma of the Breast: A Cadaveric Case Report

“…In those cases that progressed to LC, overall survival increased from three months to seven months with the use of aromatase inhibitors [ 11 ]. When comparing subtypes of breast cancer, human epidermal growth factor receptor 2 (HER2)-positive breast cancer metastasizes to the brain more frequently [ 12 ]. Treatment guidelines depend on the number of brain metastases, with options being surgical resection, stereotactic radiosurgery, whole-brain radiotherapy, and a combination of systemic therapies, including but not limited to trastuzumab and tucatinib [ 12 ].…”

Combination of radiotherapy and targeted therapy for HER2-positive breast cancer brain metastases

“…Stavrou et al compiled a schematic diagram to guide us on which treatment method to choose based on the prognosis, tumor size, and the number of BCBM patients [ 79 ]. Chan et al developed an algorithm for the treatment of HER2-positive BCBM [ 80 ]. They recommend local therapy with surgery, SRS, or WBRT before systemic therapy.…”

The systemic management of central nervous system metastases and leptomeningeal disease from advanced lung, melanoma, and breast cancer with molecular drivers: An Australian perspective

“…More clinical trials are now including patients with brain metastasis, which has become a necessity given increased survival in the context of newer systemic treatments with improved extracranial disease control. 32 Most of these include the Her-2-targeted TKIs that are known to penetrate the blood-brain barrier, such as lapatinib, neratinib, afatinib, tucatinib, pyrotinib, and epertinib 33 (Table 1).…”

“…Up to 40–50% of patients with breast cancer develop brain metastases over the course of their disease, with the Her2‐positive and triple‐negative molecular subtypes having the highest incidence. More clinical trials are now including patients with brain metastasis, which has become a necessity given increased survival in the context of newer systemic treatments with improved extracranial disease control 32 . Most of these include the Her‐2‐targeted TKIs that are known to penetrate the blood–brain barrier, such as lapatinib, neratinib, afatinib, tucatinib, pyrotinib, and epertinib 33 (Table 1).…”