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Challenges in the treatment of breast cancer brain metastases: evidence, unresolved questions, and a practical algorithm

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Abstract

Breast cancer is the leading cause of brain metastases in women. Large randomized clinical trials that have evaluated local therapies in patients with brain metastases include patients with brain metastases from a variety of cancer types. The incidence of brain metastases in the breast cancer population continues to grow, which is, aside from the rising breast cancer incidence, mainly attributable to improvements in systemic therapies leading to more durable control of extracranial metastatic disease and prolonged survival. The management of breast cancer brain metastases remains challenging, even more so with the continued advancement of local and highly effective systemic therapies. For most patients, a metastases-directed initial approach (i.e., radiation, surgery) represents the most appropriate initial therapy. Treatment should be based on multidisciplinary team discussions and a shared decision with the patients taking into account the risks and benefits of each therapeutic modality with the goal of prolonging survival while maintaining quality of life. In this narrative review, a multidisciplinary group of experts will address challenging questions in the context of current scientific literature and propose a therapeutic algorithm for breast cancer patients with brain metastases.

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Authors and Affiliations

  1. Department of Experimental and Clinical Biomedical Sciences “M. Serio”, University of Florence, Florence, Italy

    I. Meattini

  2. Oncology Department, Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy

    I. Meattini

  3. University Hospital of Zurich, The University of Zurich, Zurich, Switzerland

    N. Andratschke

  4. Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK

    A. M. Kirby

  5. Neurosurgery Department, Rambam Medical Center, Haifa, Israel

    G. Sviri

  6. Department of Experimental Clinical Oncology, Aarhus University, Aarhus C, Denmark

    B. V. Offersen

  7. Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark

    B. V. Offersen

  8. Université Paris, Sciences et Lettres, Paris, France

    P. Poortmans

  9. Sheba Tel Hashomer, Ramat Gan, Israel

    O. Kaidar Person

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Icro Meattini has no conflict of interest. Nicolaus Andratschke has no conflict of interest. Anna Kirby has no conflict of interest. Birgitte Offersen has no conflict of interest; Gill Sviri has no conflict of interest. Philip Poortmans has no conflict of interest. Orit Kaidar Person has no conflict of interest.

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Meattini, I., Andratschke, N., Kirby, A.M. et al. Challenges in the treatment of breast cancer brain metastases: evidence, unresolved questions, and a practical algorithm. Clin Transl Oncol 22, 1698–1709 (2020). https://doi.org/10.1007/s12094-020-02333-7

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