Dr. Ruddy on the Management of CNS Metastases in HER2+ Breast Cancer

Kathryn Ruddy, MD, associate professor of Oncology, Mayo Clinic, discusses the management of central nervous system (CNS) metastases in HER2-positive breast cancer.

CNS metastases are relatively common in women with HER2-positive breast cancer. says Ruddy. There are drugs that can penetrate the blood-brain barrier into the CNS such as the combination of capecitabine and lapatinib (Tykerb), explains Ruddy.

In general, HER2-positive breast cancer tends to be treated with the combination of an anti-estrogen or chemotherapy agent with at least one HER2-directed treatment. These combinations are also a fitting approach for patients with CNS disease, adds Ruddy. Moreover, radiation therapy is another modality that is used to control CNS disease. The ongoing phase II RTOG1119 clinical trial is investigating the use of lapatinib and whole brain radiotherapy as a means of controlling brain metastases in HER2-positive disease. Investigators are using stereotactic radiosurgery, which is a type of radiation that is delivered directly to the tumor at a single, high dose.