What is your recommended treatment sequencing strategy in patients with HER2+ breast cancer and leptomeningeal carcinomatosis?

HER2+ breast cancer and leptomeningeal carcinomatosis is a very challenging situation but we have more options than ever before. While the DB-12 study excluded patients with leptomeningeal metastases, T-DXd (trastuzumab deruxtecan) has shown excellent activity in retrospective series and small prosp...

Yes. Data is accumulating on T-Dxd in CNS, both parenchymal and leptomeningeal metastases. Smaller trials, such as the DEBBRAH trial, and retrospective data, such as the ROSET-BM study, have reported on the potential efficacy and safety of T-Dxd on leptomeningeal carcinomatosis. Considering the lack...

Our data for patients with leptomeningeal disease is limited because these patients are usually excluded from clinical trials. However, I think it's reasonable to consider T-DXd given evidence of CNS penetration.