# HER2-positive brain metastases

Source: https://onco.cc/terms/her2-brain-metastases/  
OnCo record `her2-brain-metastases` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Up to half of women with metastatic HER2-positive breast cancer develop brain metastases, because antibodies control the body but historically not the brain.

## Summary

Incidence 30-50% in metastatic HER2+ disease. Local therapy (radiosurgery, surgery, whole-brain RT) was the mainstay; tucatinib (HER2CLIMB: CNS-PFS HR 0.32) and T-DXd (DESTINY-Breast12: intracranial ORR 71.7%) now provide systemic control, allowing deferral of radiation in selected patients. Neratinib and pyrotinib have modest CNS activity.

## Fields

- Kind: Term
- Last checked: 2026-09-07

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Brain_metastasis
- ClinicalTrials.gov NCT02614794: HER2CLIMB: https://clinicaltrials.gov/study/NCT02614794
- ClinicalTrials.gov NCT04739761: DESTINY-Breast12: https://clinicaltrials.gov/study/NCT04739761

## Connected records

- cancers: [Brain metastases (secondary brain tumours)](https://onco.cc/cancers/secondary-brain-tumours/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HER2-positive breast cancer with brain metastases](https://onco.cc/cancers/her2-positive-breast-brain-metastases/)
- technologies: [MRI](https://onco.cc/technologies/mri/), [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- drugs: [Neratinib](https://onco.cc/drugs/neratinib/), [Trastuzumab deruxtecan](https://onco.cc/drugs/trastuzumab-deruxtecan/), [Tucatinib](https://onco.cc/drugs/tucatinib/)
- trials: [DESTINY-Breast12](https://onco.cc/trials/destiny-breast12/), [HER2CLIMB](https://onco.cc/trials/her2climb/)
- pairings: [Tucatinib + trastuzumab + capecitabine for brain metastases](https://onco.cc/pairings/tucatinib-triplet-brain-mets/)
- ideas: [Deliver CAR-T cells straight into the fluid around the brain](https://onco.cc/ideas/idea-bio2-intraventricular-car-t/), [Prevention trials aimed only at brain metastasis](https://onco.cc/ideas/idea-bio2-brain-met-prevention-trials/), [Stop excluding brain metastases from cancer trials](https://onco.cc/ideas/idea-bio2-cns-cohort-mandate/), [Systemic-first management of HER2-positive brain metastases](https://onco.cc/ideas/idea-cns-first-adc-strategy/), [Use the brain's own transport door to carry antibody drugs across](https://onco.cc/ideas/idea-bio2-transferrin-shuttle-adc/)
- bottlenecks: [The brain: barrier and sanctuary](https://onco.cc/bottlenecks/b-brain-delivery/)
- pathways: [Organ tropism: seed and soil](https://onco.cc/pathways/organ-tropism-seed-soil/), [The blood-brain barrier & brain metastasis](https://onco.cc/pathways/blood-brain-barrier-metastasis/)

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