Breast cancer

Brain metastases in patients with HER2+ breast cancer

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Educational Objective: Gain insight into the appropriateness of systemic therapies for patients with HER2+ metastatic breast cancer, including brain metastases.
Specialty: Medical oncology, Clinical oncology, (Obstetrics & Gynaecology)
Target Audience: CME (basic, intermediate), Residents (senior)
Latest update: April 2024

The brain is a common site of metastasis in patients with HER2+ breast cancer. The incidence of brain metastases is increasing due to improved diagnostic techniques but also due to increased survival of the patients through new systemic therapies in both the early and advanced stages. Treatment of patients with HER2+ metastatic disease including brain metastases usually consists of a multimodality approach, including both local treatment of the brain metastases and systemic therapy. Historically, patients with brain metastases have been excluded from most registration studies of systemic treatments. More recent trials started to include also patients presenting with brain metastases (active or stable). In a short window of time, new drugs for HER2+ metastatic breast cancer have become available. This created both clinical opportunity and uncertainty regarding the selection and sequencing of therapy.

For all the cases included in this CME course, local therapy of brain lesions was performed if feasible.

Regulatory approval status of targeted therapies for HER2+ metastatic breast cancer (MBC, status 2 April 2024)