CARALOS, CARLA MAE M.

BSN 3YA-4

Breast cancer is the second most common primary tumor associated with metastases to the
central nervous system (CNS). Patients with metastatic HER2-positive or triple-negative breast
cancer (estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, HER2-negative)
are most likely to develop parenchymal brain metastases. The leptomeningeal disease is less
common, but it occurs in all breast cancer subtypes, including lobular breast cancer. Surgery,
radiation, intravenous or intrathecal chemotherapy, and/or targeted approaches may be used
as initial treatment strategies. Epidemiology of breast cancer brain metastases, and differences
in clinical behavior and natural history by tumor subtype, and important factors to consider in
the multidisciplinary treatment of these patients. 

Central nervous system (CNS) metastases are common in patients with HER2-positive
metastatic breast cancer and are a difficult complication to treat. The prognosis is determined
by a number of clinical factors, including age, performance status, systemic disease burden, and
the number of brain metastases, among others. Surgical resection, stereotactic radiosurgery,
whole-brain radiation therapy, chemotherapy, and targeted agents are all options for
treatment. Because there is a lack of randomized, prospective data to guide treatment
selection, the timing and appropriate use of treatment options necessitate multidisciplinary
collaboration. This chapter will discuss potential approaches and novel therapies in clinical
development, as well as current treatment options for patients with CNS metastases from
HER2-positive breast cancer.

Cerebral metastases are the most common type of brain tumor in adults, accounting for more
than half of all brain tumors of all ages. They account for only 6% of all pediatric brain tumor
cases, however. Approximately 6% to 14% of cancer patients develop brain metastases during
their illness.26 The highest incidence of brain metastasis is seen in the fifth to seventh decades
of life, and it affects both men and women equally. In men, lung cancer is the most common
cause of brain metastasis, while in women, breast carcinomas are the most common cause of
metastases. In men, lung cancer is the most common cause of brain metastasis, while in
women, breast carcinomas are the most common cause of metastases. The time elapsed
between the diagnosis of primary cancer and the development of brain metastasis is
determined by the histology of primary cancer; breast cancer and melanoma have the longest
intervals (mean, 2-3 years), while lung cancer has the shortest (mean, 4.5 months).