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Thomas Bachelot1, Caroline Bailleux2, Amélie Darlix3

  • 1Département de cancérologie médicale, centre Léon-Bérard, 28 rue Laennec, 69373 Lyon, France.

Bulletin Du Cancer
|December 31, 2021
PubMed
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Metastatic breast cancer, especially HER2-positive, can spread to the brain. Systemic anti-HER2 treatments and local therapies like surgery or radiotherapy are key for managing brain metastases (BM).

Area of Science:

  • Oncology
  • Neuro-oncology
  • Genetics

Background:

  • Metastatic breast cancer (MBC) is a significant health concern, with brain metastases (BM) being particularly prevalent in HER2-amplified subtypes.
  • The ER-/HER2+ subgroup of MBC exhibits a high cumulative incidence of BM, reaching up to 49%.

Observation:

  • Systemic anti-HER2 therapies have markedly improved life expectancy for patients with HER2-positive MBC, even with brain involvement.
  • Treatment strategies for BM involve a combination of local interventions and systemic therapies tailored to the individual patient.
  • Local treatments prioritize surgery for large metastases and stereotactic radiotherapy, while cautioning against whole-brain irradiation due to cognitive toxicities and lack of survival benefit.

Findings:

  • All available systemic anti-HER2 treatments demonstrate efficacy against BM in HER2+ breast cancer.
Keywords:
Brain metastasesBreast cancerCancer du seinHER2 over-expressionHER2-positifMétastases cérébralesStratégieTreatment strategythérapeutique

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  • Treatment decisions for BM should consider the activity of systemic therapies on both the brain and systemic disease.
  • Continuing current systemic treatment is recommended if BM progresses without systemic progression and can be managed locally.

    • Implications:

    • Emerging randomized clinical trials are evaluating treatments for patients with active brain disease.
    • The triple combination of tucatinib, trastuzumab, and capecitabine has shown initial benefit in patients with HER2+ breast cancer and BM.
    • Further research and clinical trials are crucial for optimizing treatment strategies and improving outcomes for patients with HER2+ MBC and BM.