Breast cancer
Brain metastases in patients with HER2+ breast cancer

Hermione (78 years old)

Hermione, 78 years old, complains of an intense headache since 3 weeks.

Assessment summary

  • Medical history: diagnosis of HER2+ metastatic breast cancer 6 years ago
    • Prior systemic therapy (3 lines):
      • Paclitaxel + trastuzumab + pertuzumab
      • T-DM1
      • Lapatinib + capecitabine (ongoing)
    • Prior local treatment: SRS of 2 frontal brain lesions after 2nd-line of systemic treatment
  • ECOG PS: 2
  • Brain MRI: extensive linear leptomeningeal disease (LMD)
  • Cerebro-spinal fluid (CSF) analysis: elevated protein (75 mg/dl), presence of pathologic cells
  • No response of the patient’s symptoms on steroids

Which of the following treatment options would you choose for this patient?