Integrating CNS Risk Into Treatment Sequencing for HER2 Positive Metastatic Breast Cancer

This segment focuses on the critical role of central nervous system involvement in shaping treatment decisions for patients with HER2 positive metastatic breast cancer. The discussion highlights how baseline CNS risk and the likelihood of future brain metastases are increasingly considered when selecting and sequencing systemic therapies. Panelists describe how the availability of CNS active agents, particularly tucatinib based regimens, has shifted the traditional balance between systemic therapy and local interventions such as surgery or radiation. Emerging data for antibody drug conjugates are also discussed in the context of intracranial activity and overall disease control. Clinicians reflect on how these advances allow for more proactive CNS focused strategies, potentially delaying or complementing local therapy while maintaining systemic disease management. Practical considerations include timing of brain imaging, coordination with radiation oncology, and tailoring treatment to disease burden and patient symptoms. This segment underscores the importance of anticipating CNS involvement to optimize both survival and quality of life outcomes.