Breast cancer
Brain metastases in patients with HER2+ breast cancer

Anna (66 years old)

Anna is a 66-year-old retired nurse. She was diagnosed with HR- HER2+ metastatic breast cancer almost 3 years ago.

  • No relevant comorbidities/medical history
  • ECOG PS: 1
  • First-line treatment for brain and lung metastases:
    • SRS of 3 brain lesions
    • Paclitaxel + trastuzumab and pertuzumab for 22 months (paclitaxel stopped due to neuropathy after 18 infusions)
  • At progression (lung), therapy switched to T-DM1
  • 8 months later, progression of 2 of the previously treated brain metastases (mild symptoms) and new lesions of the liver (cytolysis 3x ULN)

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