Central Nervous System Metastases in HER-2–Overexpressing Metastatic Breast Cancer: A Treatment Challenge

Abstract

Abstract Learning Objectives After completing this course, the reader should be able to: Assess the risk and prognostic factors for CNS metastasis in HER-2–overexpressing MBC.Administer the standard treatment modalities for CNS metastases of MBC.Evaluate innovative systemic approaches for CNS metastases of MBC. CME This article is available for continuing medical education credit at CME.TheOncologist.com With improvements in diagnostic and therapeutic options and a corresponding improvement in survival, central nervous system (CNS) metastasis is becoming a more frequent diagnosis in breast cancer patients. It can be assumed that up to 30% of metastatic breast cancer (MBC) patients may experience CNS metastasis during the course of their disease. Moreover, it has been reported that patients with human epidermal growth factor receptor (HER)-2–overexpressing MBC are at a higher risk for CNS involvement. Whereas locoregional treatment modalities such as surgery, radiosurgery, and whole-brain radiotherapy still must be considered as the treatment of first choice, the armamentarium of systemic treatment modalities has been expanded by the introduction of small molecules such as the tyrosine kinase inhibitors. Rather than analyzing the risk factors for the development of CNS metastasis and reviewing the standard diagnostic and therapeutic approaches in patients with CNS involvement, this review focuses specifically on systemic treatment modalities in patients suffering from CNS metastasis from HER-2–overexpressing MBC.