How do you manage patients with HER2 positive breast cancer who have progressive CNS metastases after prior exposure to pertuzumab, trastuzumab, TDM1, and lapatinib?

At our institution we have 3 clinical trials that could be considered but would need more information to match against eligibility criteria.

1. HER2-CLIMB with Tucatanib excludes prior capecitabone. Lapatanib is a relative contraindication depending on duration. This is an exciting drug unless ineligible

2 BriaVax: a whole cell vaccine with low dose cyclophosphamide to suppress supressor t cells. interferon is also injected into vaccine injection sites. This study more specifically targeting brain metastases. Again would need to check eligibility

3. ATTAIN- This irenotecan derivative is randomized against standard of care IF THE BRAIN METS ARE STABLE.

The above trials are probably more widely available and in places more geographically a...