Breast cancer
Brain metastases in patients with HER2+ breast cancer

Jenna (38 years old)

Jenna, 38 years old, was diagnosed with HR+ HER2+ metastatic breast cancer 18 months ago. She has a follow-up visit today.

  • Medical history:
    • 18 months ago: diagnosis metastatic breast cancer (liver, mediastinal lymph nodes)
    • Tumour biology (liver biopsy): ER 90%, PgR 20%, HER2 IHC 3+
    • Treated with chemotherapy + dual HER2 blockade, ongoing maintenance dual blockade (trastuzumab + pertuzumab every 3 weeks) and endocrine therapy (AI + LHRH analogue)
  • No relevant comorbidities
  • Asymptomatic
  • ECOG PS: 0
  • PET-CT: progression of the metastatic disease (liver and mediastinal lymph nodes) and suspicion of brain lesion
  • Brain MRI: 2 metastases in the cerebellum

Following local treatment of the brain lesions, which of the following treatment options would you choose for this patient in addition to endocrine therapy?