What is recommended for patients with HER2 positive cancer that has spread to the brain?

This paper gave recommendations for treating patients with human epidermal growth factor receptor 2- positive (presence of HER2 on cancer cells) breast cancer that has spread to the brain.  

Some patients have breast cancer where human epidermal growth factor receptor 2 (HER2, a protein) is present. With developments in treatment, survival has improved. Patients with HER2 positive breast cancer are more at risk for developing brain metastases (spread of cancer to the brain). Thus, it is important to optimize treatment for brain metastases in HER2 patients. 

Experts in the field came together to develop guideline recommendations.

Patients with good performance status and effective systemic therapy options had good prognosis. Therapy for brain metastases includes surgery, radiotherapy and radiosurgery (delivering high dose radiation).

One trial studied patients with no symptoms and little metastases that had not received radiation treatment. It suggested that these patients could consider lapatinib (Tyverb) and capecitabine (Xeloda).

Recommendations:

For patients with a favorable prognosis for survival and a 1 – 4 brain metastases, treatment options include surgery with radiation.  For those with  more extensive brain metastases, whole-brain radiation may be offered. 

For patients with poor prognosis, options include radiotherapy, supportive care or palliative care.  Patients with worsening metastases despite initial radiation therapy could consider further radiation, surgery, or joining a clinical trial.

For patients whose cancer in general is not worsening at the time of brain metastasis diagnosis, treatment should not be switched.  Patients with worsening general disease at the time of brain metastasis diagnosis should receive treatment that targets HER2.

Patients with no history or symptoms of brain metastases should not receive routine brain magnetic resonance imaging (MRI, a scan) procedures.

This article provided formal, expert, consensus-based recommendations for management of brain metastases in breast cancer. 

The strength of the recommendations were generally weak. Further studies are needed.