Trastuzumab Use in Breast Cancer: Clinical Issues

John Horton, MB, ChB


Cancer Control. 2002;9(6) 

In This Article

Central Nervous System Metastases

It is perhaps not surprising that breast cancer patients with HER2-overexpressing tumors are at high risk for developing CNS metastases -- either parenchymal brain or meningeal metastases. In part, this may be due to the fact that treatment with trastuzumab is allowing patients with HER2 overexpressing metastatic disease to live longer than they previously did, thus allowing more chance for tumor growth in the "sanctuary" of the CNS to occur and become evident. The incidence of this complication seems sufficiently high that it may be reasonable to include imaging of the brain in the initial tumor staging assessment of a patient with metastatic HER2-overexpressing breast cancer even in the absence of CNS symptoms and signs.

Since CNS metastases often occur when the non-CNS component of metastases is under good control by a treatment program including trastuzumab, it seems reasonable to continue the systemic approach for these patients as the CNS metastases are treated essentially independently. Studies of prophylactic treatment to delay or prevent brain metastasis in HER2 overexpressors have not been reported.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.