Recommendation 6.0 (patients with intracranial metastases which
progress despite initial therapy)
➤ If a patient has intracranial metastases, which progress despite initial
therapy, treatment options will depend on the patient's prior therapies,
burden of disease, performance status, and overall prognosis.
Recommendation 6.1 (brain recurrence and prior WBRT; limited
recurrence
b
)
➤ For a patient with a favorable prognosis
a
and limited recurrence
b
after
treatment with WBRT, clinicians may discuss SRS, surgery, systemic
therapy, and/or additional palliative options.
For a patient with a favorable prognosis
a
and limited recurrence
b
after
treatment with SRS, clinicians may discuss repeat SRS, surgery, WB-M
+ HA, systemic therapy, and/or additional palliative options. (Moderate
recommendation; FC/IC-L)
Recommendation 6.2 (diffuse recurrence
c
)
➤ If a patient has diffuse recurrence
c
after consensus treatment with
WBRT, clinicians may discuss palliative options such as systemic therapy
(preferred) or repeat reduced dose WBRT plus memantine and/or other
palliative care options. (Weak recommendation; FC/IC-L)
Recommendation 6.3 (diffuse recurrence
c
)
➤ If a patient has diffuse recurrence
c
after treatment with SRS, clinicians
may discuss palliative options such as WB-M + HA or systemic therapy,
and/or other palliative care options. (Moderate recommendation; FC-L)
Recommendation 7.1
➤ The combination of tucatinib, and capecitabine and trastuzumab may be
offered to patients with HER2 positive metastatic breast cancer who have
brain metastases without symptomatic mass effect and whose disease has
progressed on at least one previous HER2-directed therapy for metastatic
disease. If these agents are used, local therapy may be delayed until there
is evidence of intracranial progression. (Weak recommendation; EB-L)
Recommendation 8.1 (brain recurrence and systemic therapy)
➤ For a patient who receives a standard surgical or radiotherapy-based
approach to treat brain metastases and is receiving anti-HER2-based
therapy and whose systemic disease is not progressive at the time of
brain metastasis diagnosis, clinicians should not switch systemic therapy.
(Moderate recommendation; FC-L)
Systemic Therapy
