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Systemic Therapy Approaches for Breast Cancer Brain and Leptomeningeal Metastases

  • Neuro-oncology (GJ Lesser, Section Editor)
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Opinion statement

Brain metastasis arising from breast cancer is associated with a poor prognosis. Various systemic chemotherapy and targeted therapies which are effective against breast cancer often fail to provide benefits against brain metastasis. This is mainly due to limited penetration of the therapies across the blood-brain barrier, and divergent evolution of brain metastasis compared to the primary tumor. Thus, brain metastasis is typically treated upfront with local therapies, such as surgery and radiation, followed by systemic therapies. Systemic therapies with CNS permeability are favored in patients with brain metastasis. This paper reviews various systemic therapy options for breast cancer brain metastasis.

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  1. University of Rochester, Rochester, NY, USA

    Ajay Dhakal MD & Ruth O’Regan MD

  2. Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Duke University, Durham, NC, USA

    Amanda E. D. Van Swearingen PhD & Carey K. Anders MD

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Ajay Dhakal has received institutional funding from Celcuity Inc. and Puma biotechnology for research. Ajay Dhakal has received consulting fees from Gilead and MJH life sciences. Amanda E. D. Van Swearingen has nothing to disclose. Ruth O'Regan reports grants and personal fees from Novartis, personal fees from Pfizer, personal fees from Genomic Health, personal fees from Biotheranostics, personal fees from Lilly, personal fees from PUMA, personal fees from Genentech, personal fees from Immunomedics, and personal fees from Macrogenics, outside the submitted work. Carey K. Anders reports research funding from PUMA, Lilly, Merck, Seattle Genetics, Nektar, Tesaro, G1-Therapeutics, ZION, Novartis, and Pfizer. Carey K. Anders has received consulting fees from Genentech, Eisai, IPSEN, Seattle Genetics; Astra Zeneca, Novartis, Immunomedics, Elucida, and Athenex. Carey K. Anders has received royalties from UpToDate and Jones and Bartlett outside the submitted work.

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Dhakal, A., Van Swearingen, A.E.D., O’Regan, R. et al. Systemic Therapy Approaches for Breast Cancer Brain and Leptomeningeal Metastases. Curr. Treat. Options in Oncol. 23, 1457–1476 (2022). https://doi.org/10.1007/s11864-022-01011-w

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