Brian Czerniecki, MD, PhD, chair and senior member, Department of Breast Oncology at Moffitt Cancer Center, discusses treatment options for patients with HER2-positive breast cancer who have brain metastases.

Local or systemic HER2-directed therapies are critical in treating patients with brain metastases, says Czerniecki.

These agents may be delivered into the brain in the central nervous system (CNS) via CNS catheters such as the MAYA balloon catheter, explains Czerniecki. The MAYA catheter, placed in the patient’s cerebrospinal fluid, can deliver higher levels of the targeted agent across the blood–brain barrier compared with systemic therapy alone.

Additionally, TKIs including tucatinib (Tukysa), neratinib (Nerlynx), and lapatinib (Tykerb) have demonstrated some utility in patients with HER2-positive disease and brain metastases, says Czerniecki.

For example, lapatinib is a smaller molecule that can cross the blood–brain barrier. Tucatinib, which was recently granted FDA approval in metastatic HER2-positive breast cancer, has demonstrated CNS activity as well, concludes Czerniecki.