Dr. Anders on Sequencing Strategies in the Setting of HER2+ Brain Metastases

Carey Anders, MD, medical director, Brain and Spine Metastasis Program, and medical oncologist, Duke Cancer Institute, discusses sequencing strategies in the setting of HER2-positive breast cancer with brain metastases.

Currently, when a patient is diagnosed with brain metastases, a radiation therapist and neurosurgeon are brought into the decision-making process, says Anders. If the patient has a mass-occupying solitary lesion that’s causing significant symptoms, or has an unknown histology, they’ll typically undergo a neurosurgical resection followed by radiosurgery. If the patient doesn't undergo neurosurgery, radiation therapy is administered as local therapy to the metastatic lesion, explains Anders.

The systemic therapy that is sequenced after local therapy has to be selected very carefully. In a patient with HER2-positive disease who has been treated with local therapy and doesn’t have progression in the extracranial compartment, the same systemic therapy is continued in accordance with the ASCO guidelines. In a patient with concurrent progressive extracranial disease, the systemic therapy is often switched in an attempt to treat the intercranial, but also the extracranial, disease progression, concludes Anders.