Key Points
➤ Human epidermal growth factor receptor 2 (HER2)-targeted therapy is
recommended for patients with HER2-positive advanced breast cancer,
except for those with clinical congestive heart failure or significantly
compromised left ventricular ejection fraction, who should be evaluated on a
case-by-case basis.
Brain Metastases
Recommendation 1.0
➤ Multidisciplinary collaboration to formulate treatment and care plans and
disease management for patients with HER2-positive metastatic breast
cancer should be the standard of care. (Strong recommendation; EB-B-I)
Recommendation 2.1. (single brain metastasis, favorable
prognosis
a
)
➤ If a patient has a favorable prognosis
a
for survival and a single brain
metastasis, the patient should be evaluated by an experienced neurosurgeon
for discussion of the option of surgical resection, particularly if the
metastasis is >3 to 4 cm and/or if there is evidence of symptomatic mass
effect. (Strong recommendation; FC/IC-I)
Recommendation 2.2
➤ If a patient has a favorable prognosis
a
and a single brain metastasis <3 to
4 cm without symptomatic mass effect, clinicians may offer either
stereotactic radiosurgery (SRS) or surgical resection, depending on the
location and surgical accessibility of the tumor, need for tissue diagnosis,
and other considerations, such as medical risk factors for surgery and patient
preference. (Weak recommendation; FC-I)
Recommendation 2.3
➤ If a patient has a favorable prognosis
a
and a single brain metastasis
<2 cm without symptomatic mass effect and who has an option to proceed
with HER2-directed therapy with known central nervous system (CNS)
activity, then clinicians and patients may discuss options including SRS
or deferring local therapy with a multidisciplinary team (MDT). (Moderate
recommendation; IC-L)
Local Therapy
