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Evolving management of HER2+ breast cancer brain metastases and leptomeningeal disease

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Abstract

Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are at a particularly high risk of breast cancer brain metastasis (BCBM) and leptomeningeal disease (LMD). Improvements in systemic therapy have translated to improved survival for patients with HER2-positive BCBM and LMD. However, the optimal management of these cases is rapidly evolving and requires a multidisciplinary approach. Herein, a team of radiation oncologists, medical oncologists, neuro-oncologists, and breast surgeon created a review of the evolving management of HER2-positive BCBM and LMD. We assess the epidemiology, diagnosis, and evolving treatment options for patients with HER2-positive BCBM and LMD, as well as the ongoing prospective clinical trials enrolling these patients. The management of HER2-positive BCBM and LMD represents an increasingly common challenge that involves the coordination of local and systemic therapy. Advances in systemic therapy have resulted in an improved prognosis, and promising targeted therapies currently under prospective investigation have the potential to further benefit these patients.

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Authors and Affiliations

  1. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., Tampa, FL, 33612, USA

    Matthew N. Mills, Whitney King & Kamran A. Ahmed

  2. Department of Breast Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA

    Aixa Soyano, Brian J. Czerniecki, Hatem Soliman & Hyo S. Han

  3. Department of Neuro-Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 33612, USA

    Yolanda Pina & Peter A. Forsyth

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  1. Matthew N. Mills
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Contributions

KA, WK, and MM designed the study and prepared the manuscript. MM, WK, AS, YP, PF, BC, HS, HH, and KA assisted with data analysis, data interpretation, manuscript editing, and review.

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Correspondence to Kamran A. Ahmed.

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Conflict of interest

Peter A. Forsyth has received research funding from Pfizer and Celgene and is on the advisory boards of Novocure, BTG, Inovio, AbbVie, Ziopharm, Tocagen, and Pfizer. Hatem Soliman serves as a consultant for Astrazeneca, Celgene, Novartis, PUMA, and Eisai. Brian J Czerniecki has intellectual property on a HER2 dendritic cell vaccine. Hyo S. Han declares that she has received a speaker’s honorarium from Lilly Pharmaceuticals, research funding from Abbvie, Arvinas, GSK, Marker therapeutic, Novartis, Bristol-Myers Squibb, Pfizer, SeattleGenetics, Prescient, Horizon, Zymeworks and Karyopharm. Kamran A. Ahmed has received research funding from Bristol-Myers Squibb, Eli Lilly, and Genentech.

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This study was approved by the University of South Florida Institutional Review Board.

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Mills, M.N., King, W., Soyano, A. et al. Evolving management of HER2+ breast cancer brain metastases and leptomeningeal disease. J Neurooncol 157, 249–269 (2022). https://doi.org/10.1007/s11060-022-03977-x

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