CNS Metastases in HER2-Mutated NSCLC: Clinical Challenges and Treatment Considerations

Dr. Santos and Dr. Lopes address the incidence of brain metastases and management of central nervous system (CNS) metastases in patients with HER2-mutated NSCLC, a clinically significant challenge in thoracic oncology.

The faculty highlight the importance of evaluating CNS activity of systemic therapies, particularly as newer HER2-targeted agents demonstrate potential intracranial efficacy. Ability to cross the blood-brain barrier is a critical consideration when selecting therapy for patients with baseline or progressive brain metastases.

The discussion also emphasizes the continued role of local therapies, including stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT), in conjunction with systemic treatment. Multidisciplinary collaboration is presented as essential for optimizing outcomes, including durable intracranial disease control.

Overall, this section underscores that CNS disease remains a key unmet need, but emerging therapies may offer improved outcomes. Treatment decisions should integrate systemic efficacy, CNS penetration, and patient-specific factors.