36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists

36 Expert Perspectives in the Management of Breast Cancer Brain Metastases: A Survey of 32 International Specialists

Background/Significance

The management of HER2-positive breast cancer brain metastases is rapidly evolving as data with novel targeted therapies emerge, requiring clinicians to reevaluate their clinical approaches. This survey aimed to document current practices of breast cancer specialists regarding breast cancer brain metastases screening, monitoring, and treatment in this population to assess how these data are shaping contemporary clinical decision-making.

Materials and Methods

An international cohort of 32 clinicians with expertise in breast cancer brain metastases were invited via email to complete a 26-item survey from September to October 2024. Data were aggregated and analyzed to be utilized within a continuing medical education (CME) activity. Respondents were compensated for their participation.

Results

The 32 respondents practiced in the US (56%) and European Union (43%). Sixty percent of EU respondents reported their institution supports routine brain metastases screening in some or all patients with metastatic breast cancer compared with 0% of US-based institutions. However, more than half of all respondents (65%) agreed with EANO-ESMO guidelines that support brain metastases screening for all newly diagnosed patients with HER2-positive metastatic breast cancer. When presented with a case study examining a patient with newly identified HER2-positive breast cancer brain metastases after 12 months of trastuzumab, pertuzumab, and docetaxel (THP) therapy for which the extent of intracranial disease precluded use of local therapy other than whole-brain radiation, the top therapeutic selections were trastuzumab deruxtecan (53%) and whole-brain radiation followed by continued THP (16%) or a switch in systemic therapy (16%). Only 3% of respondents selected tucatinib plus capecitabine and trastuzumab. Nearly all respondents (91%) reported that they would be more inclined to offer systemic therapy in lieu of local therapy for a patient with newly diagnosed, HER2-positive breast cancer brain metastases. However, in patients with more significant disease burden, participants were divided between stereotactic radiosurgery and trastuzumab deruxtecan as their first step. Half of respondents (50%) indicated that their institutions have a specific care coordination program for patients with breast cancer brain metastases and/or caregivers.

Conclusion

While survey results reveal heterogeneity among specialists regarding the risks/benefits of early brain metastases screening in patients with breast cancer, more respondents favored the EANO-ESMO approach. Experts also were likely to consider novel systemic therapies over local treatment in patients with newly diagnosed HER2-positive breast cancer brain metastases. Further assessment of expert preferences is needed as data evolves.