Systemic Treatment for Brain Metastasis and Leptomeningeal Disease in Breast Cancer Patients

Curr Oncol Rep. 2023 Dec;25(12):1419-1430. doi: 10.1007/s11912-023-01468-4. Epub 2023 Nov 4.

Abstract

Purpose of review: Breast cancer with brain metastasis (BCBM) and leptomeningeal disease (LMD) are important clinical problems. Traditionally, patients with metastases to the brain and meninges were excluded from clinical trials; hence, robust, evidence-based treatment recommendations are lacking. In this review, we outline the systemic treatment options and ongoing clinical trials.

Recent findings: Several recent studies have added to the systemic treatment options available. Antibody-drug conjugates have changed the therapeutic landscape. Combination treatment modalities that target multiple mechanisms including disruption of the blood brain barrier are increasingly being studied. Breast cancer with brain metastases and LMD is a heterogenous disease. While the prognosis remains grim, with more systemic treatment options, patients with BCBM are now living longer. Many ongoing clinical trials hold promise to further improve outcomes.

Keywords: Brain metastases; Breast cancer; HER2+ breast cancer; Leptomeningeal disease; Systemic treatment; Triple negative breast cancer.

Publication types

  • Review

MeSH terms

  • Brain / pathology
  • Brain Neoplasms* / drug therapy
  • Brain Neoplasms* / secondary
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / pathology
  • Combined Modality Therapy
  • Female
  • Humans
  • Prognosis