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Breast Cancer

Central Nervous System Metastases in HER-2–Overexpressing Metastatic Breast Cancer: A Treatment Challenge

Department of Haematology and Oncology, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany

Key Words. CNS metastases • Metastatic breast cancer • HER-2 overexpression • Treatment modalities • Radiotherapy • Tyrosine kinase inhibitors

Correspondence: Priv. -Doz. Dr. H. J. Stemmler, LMU University of Munich – Klinikum Groβhadern, Medical Department III – Haematology & Oncology, Marchioninistr. 15, 81377 Munich, Germany. Telephone: 49-089-7095-5258; Fax: 49-089-7095-5256; e-mail: Joachim.Stemmler{at}med.uni-muenchen.de

Received February 21, 2008; accepted for publication June 3, 2008; first published online in THE ONCOLOGIST Express on July 9, 2008.

Disclosure: V.H. has received honoraria from GlaxoSmithKline for scientific talks. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

With improvements in diagnostic and therapeutic options and a corresponding improvement in survival, central nervous system (CNS) metastasis is becoming a more frequent diagnosis in breast cancer patients. It can be assumed that up to 30% of metastatic breast cancer (MBC) patients may experience CNS metastasis during the course of their disease. Moreover, it has been reported that patients with human epidermal growth factor receptor (HER)-2–overexpressing MBC are at a higher risk for CNS involvement.

Whereas locoregional treatment modalities such as surgery, radiosurgery, and whole-brain radiotherapy still must be considered as the treatment of first choice, the armamentarium of systemic treatment modalities has been expanded by the introduction of small molecules such as the tyrosine kinase inhibitors.

Rather than analyzing the risk factors for the development of CNS metastasis and reviewing the standard diagnostic and therapeutic approaches in patients with CNS involvement, this review focuses specifically on systemic treatment modalities in patients suffering from CNS metastasis from HER-2–overexpressing MBC.