Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Apr;5(4):e1274.
doi: 10.1002/cnr2.1274. Epub 2020 Sep 3.

HER2-positive breast cancer brain metastasis: A new and exciting landscape

Alexandra S Zimmer  1 , Amanda E D Van Swearingen  2 , Carey K Anders  2
Affiliations
Review

HER2-positive breast cancer brain metastasis: A new and exciting landscape

Alexandra S Zimmer et al. Cancer Rep (Hoboken). 2022 Apr.

Abstract

Background: Brain metastases (BrM) incidence is 25% to 50% in women with advanced human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Radiation and surgery are currently the main local treatment approaches for central nervous system (CNS) metastases. Systemic anti-HER2 therapy following a diagnosis of BrM improves outcomes. Previous preclinical data has helped elucidate HER2 brain trophism, the blood-brain/blood-tumor barrier(s), and the brain tumor microenvironment, all of which can lead to development of novel therapeutic options.

Recent findings: Several anti-HER2 agents are currently available and reviewed here, some of which have recently shown promising effects in BrM patients, specifically. New strategies driven by and focusing on brain metastasis-specific genomics, immunotherapy, and preventive strategies have shown promising results and are under development.

Conclusions: The field of HER2+ breast cancer, particularly for BrM, continues to evolve as new therapeutic strategies show promising results in recent clinical trials. Increasing inclusion of patients with BrM in clinical studies, and a focus on assessing their outcomes both intracranially and extracranially, is changing the landscape for patients with HER2+ CNS metastases by demonstrating the ability of newer agents to improve outcomes.

Keywords: CNS involvement; HER2-positive breast cancer; T-DM1; brain metastasis; trastuzumab; tucatinib.

PubMed Disclaimer

Conflict of interest statement

C. K. A.: Research funding PUMA, Lilly, Merck, Seattle Genetics, Nektar, Tesaro, G1‐Therapeutics; Compensated consultant role: Genentech, Eisai, IPSEN, Seattle Genetics; Astra Zeneca; Royalties: UpToDate, Jones and Bartlett.

The other authors have no conflicts requiring disclosure.

Figures

FIGURE 1
FIGURE 1
Suggested algorithm for multidisciplinary management of care for patients with HER2+ breast cancer brain metastases. BCBrM: breast cancer brain metastases; MBC: metastatic breast cancer; THP: Taxotere (Docetaxel) + Herceptin (Trastuzumab) + Perjeta (Pertuzumab); T‐DM1: ado‐trastuzumab emtansine (Kadcyla)
See this image and copyright information in PMC

References

    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. Ca‐Cancer J Clin. 2020;70(1):7‐30. - PubMed
    1. Barnholtz‐Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan Detroit cancer surveillance system. J Clin Oncol. 2004;22(14):2865‐2872. - PubMed
    1. Lin NU, Bellon JR, Winer EP. CNS metastases in breast cancer. J Clin Oncol. 2004;22(17):3608‐3617. - PubMed
    1. Tsukada Y, Fouad A, Pickren JW, Lane WW. Central nervous‐system metastasis from breast‐carcinoma‐autopsy study. Cancers. 1983;52(12):2349‐2354. - PubMed
    1. Arvold ND, Oh KS, Niemierko A, et al. Brain metastases after breast‐conserving therapy and systemic therapy: incidence and characteristics by biologic subtype. Breast Cancer Res Treat. 2012;136(1):153‐160. - PubMed

Publication types