Systemic Therapy of Central Nervous System Metastases of Breast Cancer

Abstract

Purpose of the review: Historically, systemic treatment options for patients with breast cancer brain metastases have been very limited. This review focuses on important considerations for systemic therapy as well as ongoing clinical trials evaluating novel agents.

Recent findings: For patients with hormone receptor-positive brain metastases, endocrine therapy or chemotherapy options can be considered. The role of CDK4/6 inhibitors is being explored in ongoing trials. Patients with HER2-positive disease have a number of treatment options, including ado-trastuzumab emtansine (TDM1) or lapatinib-capecitabine, and there is emerging evidence of the efficacy of neratinib- and tucatinib-based chemotherapy combinations in the CNS. Triple-negative tumors may respond to chemotherapy. Although much progress remains to be made, a number of effective systemic treatment options are emerging, particularly for patients with HER2-positive disease. Ongoing clinical trials will help define the role of novel agents.

Keywords: Brain metastases; Breast cancer; Chemotherapy; Metastatic breast cancer; Targeted therapies.