Breast Cancer Brain Metastases: Current Understanding and Future Directions

To examine recent advances in understanding breast cancer brain metastases (BCBM), with emphasis on metastatic mechanisms, tumour-microenvironment interactions, receptor discordance between primary breast tumours and brain metastases, diagnostic innovations, and therapeutic strategies. The review sought to clarify how these developments inform precision management and identify priorities for future research.

Studies implicate JAK-STAT signalling, homologous recombination deficiency, c-MYC, PI3K/AKT/mTOR, and RET in BCBM progression. Tumour cells adapt via neuronal mimicry, metabolic reprogramming, and crosstalk with astrocytes and microglia. Receptor discordance between primary breast cancers and brain metastases occurs in up to one-third of cases and may alter systemic therapy. Emerging tools including liquid biopsy, spatial transcriptomics, and radiomics offer minimally invasive approaches for molecular profiling, spatial mapping, and imaging-based phenotyping to guide personalised management. Machine learning supports prognostication and imaging interpretation, though external validation is limited. BCBM reflect complex tumour-brain interactions. Advances in molecular understanding and diagnostics are beginning to inform the development of targeted therapies. Future work may benefit from integrating cancer neuroscience with computational modelling, standardise diagnostic platforms, and test the survival impact of receptor reassessment in prospective trials.