Would you change treatment for denovo stage IV breast cancer Her 2 positive, ER positive in remission now with isolated brain metastasis?

Topics: Breast Cancer • Medical Oncology • Her2+ • HR+

The patient received THP and now is on maintenance HP when she developed CNS disease.

Answer from: Medical Oncologist at Academic Institution

I would not change systemic treatment for such a patient if they have stable disease outside the brain. The intracranial disease should be treated with SRS or WBRT or surgery, as the case may be. With the various anti Her-2 treatment options in this setting, namely trastuzumab, pertuzumab, T-DM1 and...

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Medical Oncologist at Springfield Clinic
Thanks for your response. I had noted the recent p...

Medical Oncologist at University of Nebraska Medical Center
If this patient has a systemic progression of dise...

Medical Oncologist at Springfield Clinic
Thank you.

Medical Oncologist at Cancer Care Specialists/Renown Oncology/UNR
If consider switching, Tucatinib trial is the way ...

Answer from: Medical Oncologist at Academic Institution

The TBCRC 022 phase II did have an impressive composite CNS ORR 49% in the cohort "3" with Neratinib and Xeloda as recently highlighted in JCO. The NALA trial will be presented in a few weeks at ASCO but in the 3rd Line HER2+ MBC setting. Unfortunately, the although isolated brain met is likely a ha...

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Medical Oncologist at Warren Alpert Medical School of Brown University
I think that it depends upon the extent of CNS dis...

Answer from: Medical Oncologist at Community Practice

I agree with @Milana V. Dolezal's approach. There is a risk of progression outside CNS in this case given new brain mets, One could continue same systemic therapy but considering small molecule inhibitors like Lapatinib or Neratinib concurrent with SRS could give better CNS control. These agents sho...

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