Breast cancer
Brain metastases in patients with HER2+ breast cancer

Liliana (48 years old)

Liliana, 48 years old, is the owner of the tearoom “Lily’s cozy place”. She serves a very nice selection of homemade cakes and pastries, cappuccinos, teas and milk shakes. Her amazing chocolate cake is famous in town and pairs delicious moist chocolatey cake layers with a rich and silky chocolate buttercream. Liliana was diagnosed with breast cancer almost 4 years ago.

  • No relevant comorbidities
  • 4 years ago: diagnosis de novo metastatic breast cancer (liver)
    • Treated with paclitaxel + trastuzumab and pertuzumab
  • 2 years ago: progression in liver and limited number of brain metastases
    • SRS to 2 brain lesions, stable
    • Enrolled in clinical trial; received treatment with trastuzumab deruxtecan
  • Current situation:
    • Progressive liver disease
    • Intracranial progression: 3 new lesions, all <1 cm
    • ECOG PS: 0
    • Headache

Following local therapy of the brain metastases, which of the following treatment options would you choose for this patient?