HER2-positive breast cancer with brain metastases: lines of therapy
5 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Maintenance
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | First-line maintenance to delay brain progression | Tucatinib added to trastuzumab and pertuzumab maintenance after induction chemotherapy (HER2CLIMB-05). | 92 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Later lines | Neratinib or lapatinib with capecitabine, trastuzumab emtansine with tucatinib (HER2CLIMB-02), repeat radiosurgery, or a clinical trial. | 84 |
Special situations
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Limited brain metastases at first presentation | Stereotactic radiosurgery to each lesion, or surgery for a large symptomatic lesion, followed by HER2-directed systemic therapy; whole-brain radiotherapy reserved for many lesions. | 65 | ||
| All comers | Active brain metastases after trastuzumab, pertuzumab and trastuzumab emtansine | Tucatinib with trastuzumab and capecitabine (HER2CLIMB), which improved survival and delayed brain progression. | 89 | ||
| All comers | Brain metastases, stable or active, second line | Trastuzumab deruxtecan, with intracranial responses in most patients (DESTINY-Breast12), positioned as second-line therapy after DESTINY-Breast03. | 97 |
Sequence and caution pairings
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.