Treatment of Brain Metastases in HER2-Negative Breast Cancer After Prior Local Therapy

This protocol covers the systemic management of CNS metastases in patients with HER2-negative breast cancer whose brain disease has progressed after prior local brain-directed treatment.

Clinical scenario: Patients with HER2-negative breast cancer presenting with progressive brain metastases following prior local treatment directed at the CNS. This distinct situation — defined by HER2-negative receptor status combined with post-local-treatment intracranial progression — requires a specific systemic approach beyond the initial local intervention.

Approach overview: Standard systemic chemotherapy is among the options considered in this setting. For patients with certain hormone receptor profiles within the HER2-negative subgroup, an additional agent class may be applicable. Full eligibility criteria, agent selection, and sequencing are provided in the structured protocol.

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References

For HER2-negative breast cancer patients with progressive BM after local treatment, standard chemotherapy, such as capecitabine, eribulin or carboplatin and bevacizumab, may be considered.

Abemaciclib showed an intracranial clinical benefit rate defined as complete response plus partial response plus stable disease persisting for 6 months of 25% and a median progression-free survival (PFS) of 4.4 months in heavily pre-treated patients with BM from estrogen receptor-positive/HER2-negative breast cancer.

DOI: 10.1016/j.annonc.2021.07.016

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