What systemic therapies would you consider for a patient with HER2 positive breast cancer with progressive brain metastases despite whole brain radiation, but no systemic disease?

This is one of the most challenging scenarios that we face in breast oncology . Radiation therapy remains the mainstay of treatment. For patients with progressive brain mets after whole brain radiation, there may be a role for gammaknife.

Regarding systemic therapy, there is a paucity of data regardi...