Systemic treatment in breast-cancer patients with brain metastasis

Breast cancer is the second most common cause of CNS metastasis, following lung cancer. With better control of systemic disease, the CNS is emerging as a sanctuary site of relapse in patients with otherwise controlled cancer.

Standard therapy for brain metastasis is currently whole-brain radiotherapy. Other treatment modalities include surgery and radiosurgery in selected cases, corticosteroids, and systemic chemotherapy. Little progress has been made in chemotherapy for the treatment of brain metastases, partly because tumors develop brain metastases at a stage when they become totally chemoresistant. Nevertheless, new treatment choices have emerged considering cytotoxic and biological agents for the treatment of CNS metastases in patients with breast cancer.

In this review, we aimed to review current and future treatment options in the systemic treatment of brain metastases of breast cancer.

Corticosteroids, anti-epileptic drugs, and radiotherapy remain the cornerstones of management. The efficacy of conventional cytotoxic chemotherapeutics is limited. Novel biologic agents, lapatinib being the most promising, are currently investigated in the treatment of brain metastases of breast cancer with promising results.