Systemic Treatment for Patients with HER2-Positive Breast Cancer and Brain Metastases

There is no consensus on the treatment of brain metastases in patients with HER2-positive breast cancer. This article reported a patient attained long intracranial control and survival with the use of multiple anti-HER2 agents. Treatment of brain metastases in patients with HER2-positive breast cancer should involve both local therapies and systemic anti-HER2 agents. Radiotherapy and surgery can disrupt the blood-brain barrier. This, in turn, allows the larger molecules like trastuzumab and pertuzumab to penetrate through for better control in the brain metastases. Novel anti-HER2 agents including lapatinib, neratinib, trastuzumab emtansine (TDM1), trastuzumab deruxtecan (T-DXd) can penetrate the bloodbrain barrier and can attain significant improvement in the response of the brain metastases.