Scandurra Giuseppa, Lombardo Valentina, Scibilia Giuseppe, Sambataro Daniela, Gebbia Vittorio, Scollo Paolo, Pecorino Basilio, Valerio Maria Rosaria
Medical Oncology Unit, Cannizzaro Hospital, 95126 Catania, Italy.
Department of the Medicine and Surgery, Kore University, 94100 Enna, Italy.
Cancers (Basel). 2024 Jul 5;16(13):2466. doi: 10.3390/cancers16132466.
Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood-brain barrier. While radiotherapy is still fundamental in local therapy, its use is associated with cognitive adverse effects and limited long-term control, necessitating the exploration of alternative treatments. Targeted therapies, including tyrosine kinase inhibitors, monoclonal antibodies, and antibody-drug conjugates, offer promising options for HER2+ breast cancer patients with BM. Clinical trials have demonstrated the efficacy of these agents in controlling tumor growth and improving patient outcomes, posing the question of whether radiotherapy is always the unique choice in treating this cancer. Ongoing research into novel anti-HER2 antibodies and innovative combination therapies holds promise for advancing treatment outcomes and enhancing patient care in this clinical scenario. This narrative review provides a comprehensive overview of traditional medical treatments, molecularly targeted therapy and investigational agents in the management of HER2+ breast cancer with BM, highlighting the evolving landscape and potential future directions in treatment strategies to improve patient survival and quality of life.
脑转移（BM）在HER2阳性乳腺癌的治疗中构成了重大挑战，因为近50%的HER2阳性乳腺癌患者会发生脑肿瘤。脑转移的复杂过程涉及基因突变、适应性变化以及克服血脑屏障的机制。虽然放射治疗在局部治疗中仍然是基础，但它的使用会带来认知方面的不良反应，且长期控制效果有限，因此需要探索替代治疗方法。靶向治疗，包括酪氨酸激酶抑制剂、单克隆抗体和抗体药物偶联物，为患有脑转移的HER2阳性乳腺癌患者提供了有前景的选择。临床试验已经证明了这些药物在控制肿瘤生长和改善患者预后方面的疗效，这就引发了放射治疗是否始终是治疗这种癌症的唯一选择的问题。对新型抗HER2抗体和创新联合疗法的持续研究有望在这一临床场景中改善治疗效果并提高患者护理水平。这篇叙述性综述全面概述了在治疗伴有脑转移的HER2阳性乳腺癌时的传统医学治疗、分子靶向治疗和研究性药物，突出了治疗策略不断变化的格局以及未来潜在的发展方向，以提高患者的生存率和生活质量。
