Insights from 36 Experts on Managing Breast Cancer Brain Metastases

In a significant survey conducted between September and October 2024, a cohort of 32 international specialists in breast cancer management provided their insights on the evolving landscape of brain metastases stemming from HER2-positive breast cancer. This comprehensive study aimed to document current clinical practices regarding screening, monitoring, and treatment of breast cancer brain metastases, an area of increasing clinical importance due to the emergence of novel targeted therapies.

According to Dr. Javier Cortés, an oncologist at the Hospital Clínico San Carlos in Spain and a contributor to this survey, the management of breast cancer brain metastases has become more complex as treatment options expand. "The recent advancements in targeted therapies necessitate a reassessment of clinical decision-making among healthcare professionals," Dr. Cortés stated in a press release from the Miami Breast Cancer Conference.

The survey revealed that 56% of respondents practiced in the United States, while 43% were based in the European Union. A notable difference was observed in institutional support for routine brain metastases screening: 60% of EU respondents indicated their institutions supported this practice in some or all cases, while no US-based institutions reported similar support. This disparity raises questions about the consistency of care provided to patients across different regions.

Dr. Sara Hurvitz, an expert in breast oncology at the University of California, Los Angeles, emphasized the importance of early screening. "The European Association of Neuro-Oncology and the European Society for Medical Oncology guidelines advocate for routine brain metastases screening for all newly diagnosed patients with HER2-positive metastatic breast cancer. Our survey results reflect a growing consensus on this approach, even among US practitioners who have historically been more conservative in this regard," she explained.

The survey also presented a clinical scenario involving a patient with newly diagnosed HER2-positive breast cancer brain metastases after 12 months of treatment with trastuzumab, pertuzumab, and docetaxel. The experts were asked to choose among several therapeutic options. The majority of respondents (53%) selected trastuzumab deruxtecan as the preferred treatment, while 16% favored whole-brain radiation followed by continued therapy with trastuzumab and pertuzumab.

Interestingly, only 3% opted for the combination of tucatinib, capecitabine, and trastuzumab, indicating a strong preference for novel systemic therapies over local treatment options. Dr. Komal Jhaveri, a breast cancer specialist at Memorial Sloan Kettering Cancer Center, noted, "The inclination towards systemic therapy speaks volumes about the confidence clinicians have in the efficacy of newer agents in managing brain metastases."

The survey also highlighted that 91% of respondents would prefer to offer systemic therapy in lieu of local treatment for patients with newly diagnosed HER2-positive breast cancer brain metastases. However, opinions were divided regarding initial treatment strategies for patients with a more significant disease burden, with half of the respondents indicating their institutions had specific care coordination programs for these patients.

While the survey results indicate a trend towards favoring early screening and novel therapies, there remains a notable heterogeneity in practice patterns among breast cancer specialists. Dr. Brian Moss, a researcher at the National Institutes of Health, cautioned that further assessment of expert preferences is necessary as more data emerges. He remarked, "Understanding the rationale behind these differing practices can help improve patient outcomes and standardize care in this critical area of oncology."

In conclusion, the survey sheds light on the evolving management strategies for breast cancer brain metastases and underscores the need for continued research and dialogue among specialists. As treatments continue to advance, the integration of expert perspectives will be crucial in shaping best practices and improving patient care in this challenging field of oncology.