After WBRT, what systemic therapy would you favor for maximal CNS penetrance in a patient with triple negative metastatic breast cancer and multifocal CNS disease?
Which systemic therapy do you feel maximizes CNS penetrance for triple negative breast cancer?
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With patients such as this, I would usually recommend the following:
1. Genomic testing (Strata, Foundation 1, etc.) to look for a mutation that might be targetable with a TKI that crosses the blood brain barrier well
2. Re-testing of the CNS cytology for HER2, given that we do have multiple drugs which can target HER2
3. The choice of systemic therapy would be dictated somewhat by whether or not there is also significant non-CNS disease. If this patient had only CNS metastases, I would favor capecitabine to start, given that it has the best data for penetration. SN-38 (the drug conjugate for Immu-132) does reportedly cross the BBB, but there is limited data about actual efficacy. There are currently several early stage studies that appear ...
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