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Proactive Brain Screening Using Contrast-Enhanced Brain CT Scans in HER2+ Metastatic Breast Cancer.

Gaia Griguolo1,2, Michele Bottosso1,2, Giusy Landa1,2

  • 1Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.

Clinical Cancer Research : an Official Journal of the American Association for Cancer Research
|February 9, 2026
PubMed
Summary
This summary is machine-generated.

Proactive brain CT screening in HER2+ metastatic breast cancer (mBC) patients reduced symptomatic brain metastases (BMs) and improved performance status. This supports routine imaging for early detection and better outcomes.

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Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • HER2+ metastatic breast cancer (mBC) has a high risk of brain metastases (BMs).
  • EANO-ESMO guidelines suggest proactive brain imaging for asymptomatic patients.
  • Optimal imaging strategies for BMs in HER2+ mBC remain undefined.

Purpose of the Study:

  • To retrospectively assess the impact of contrast-enhanced CT screening on symptomatic BMs.
  • To evaluate the effect of proactive imaging on patient outcomes in HER2+ mBC.

Main Methods:

  • Retrospective analysis of 148 HER2+ mBC patients treated with trastuzumab-pertuzumab and taxane (2014-2024).
  • Brain screening defined as annual contrast-enhanced brain CT scans without neurological symptoms in the first 2 years.
  • Comparison of outcomes between patients undergoing screening versus those not undergoing screening.

Main Results:

  • Patients undergoing screening had a higher cumulative incidence of BMs (30.6% vs 12.3%).
  • However, screening significantly reduced symptomatic BMs (0% vs 9.5%) and improved performance status at diagnosis.
  • A trend towards fewer BMs overall was observed in the screening group (p=0.057).

Conclusions:

  • Contrast-enhanced CT brain screening is associated with fewer symptomatic BMs in HER2+ mBC.
  • Proactive imaging may lead to better performance status at the time of BM diagnosis.
  • Further prospective studies are needed to optimize imaging timing and modalities.