Local Therapy

Systemic Therapy

Screening

Document Overview

Design and created by Guideline Central in participation with the American Society of Clinical Oncology.

Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases

American Society of Clinical Oncology

Publication Date: May 31, 2022

Page Last Updated: May 5, 2026

Recommendation Grading

Type		Benefit/harm		Evidence Quality		Strength of Recommendation
EB	Evidence-based	B	Benefits outweigh harms	H	High	Strong
CB	Consensus-based	H	Harms outweigh benefits	I	Intermediate	Moderate
IC	Informal consensus	B/H	Relative balance of benefits and harms	L	Low	Weak
IC	Informal consensus	B/H	Relative balance of benefits and harms	Ins	Insufficient	Weak

Document Overview

Document Title: Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases

Authoring Society: American Society of Clinical Oncology

Document Publication Date: May 31, 2022

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: ascopubs.org/doi/full/10.1200/JCO.22.00520

Source Citation: Ramakrishna N, Anders CK, Lin NU, et al. Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases: ASCO Guideline Update. J Clin Oncol. 2022 May 31. doi: 10.1200/JCO.22.00520.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: To provide updated evidence- and consensus-based guideline recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2)–positive advanced breast cancer up to 2021.

Scope: Management

Keywords: Advanced Breast Cancer, Brain Metastases, HER2, HER2 Positive, breast cancer

Target Patient Population: Individuals with advanced human epidermal growth factor receptor (HER2)–positive breast cancer and brain metastases.

Target Provider Population: Medical oncologists, radiation oncologists, neurosurgeons, oncology nurses

Inclusion Criteria: Female, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital, Outpatient, Radiology Services

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

Overall, what is the appropriate course of treatment for patients with HER2-positive advanced breast cancer and brain metastases?
Does the approach to local therapy of brain metastases differ in patients with HER2-positive breast cancer?
How should systemic therapy be managed in patients with HER2-positive brain metastases (including management of systemic therapy when the brain is the only site of progression versus when progression occurs in both the brain and elsewhere)?
Is there a role for systemic therapy specifically to treat brain metastases in HER2-positive breast cancer?
Should patients with HER2-positive breast cancer be screened for development of brain metastases?

Supplemental Methodology Resources: Data Supplement Evidence Tables

Number of Source Documents: 90

Literature Search Start Date: Monday, August 1, 2016

Literature Search End Date: Thursday, April 1, 2021

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases

Local Therapy

Brain Metastases

Recommendation 1.0

Recommendation 2.1. (single brain metastasis, favorable prognosis^a)

Recommendation 2.2

Recommendation 2.3

Recommendation 2.4

Recommendation 2.5

Recommendation 2.6

Recommendation 3.0

Recommendation 3.1

Recommendation 3.2

Recommendation 3.3

Recommendation 3.4

Diffuse Disease or Extensive Metastases^c

Recommendation 4.1

Recommendation 4.2.1

Recommendation 4.2.2

Recommendation 5.0 (patients with poor prognosis)

Recommendation 5.1

Recommendation 6.0 (patients with intracranial metastases which progress despite initial therapy)

Recommendation 6.1 (brain recurrence and prior WBRT; limited recurrence^b)

Recommendation 6.2 (diffuse recurrence^c)

Recommendation 6.3 (diffuse recurrence^c)

Systemic Therapy

Recommendation 7.1

Recommendation 8.1 (brain recurrence and systemic therapy)

Recommendation 8.2

Recommendation 9.1

Screening

Recommendation 10.1 (screening)

Recommendation 10.2

Recommendation Grading

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology

Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases

Local Therapy

Brain Metastases

Recommendation 1.0

Recommendation 2.1. (single brain metastasis, favorable prognosisa)

Recommendation 2.2

Recommendation 2.3

Recommendation 2.4

Recommendation 2.5

Recommendation 2.6

Recommendation 3.0

Recommendation 3.1

Recommendation 3.2

Recommendation 3.3

Recommendation 3.4

Diffuse Disease or Extensive Metastasesc

Recommendation 4.1

Recommendation 4.2.1

Recommendation 4.2.2

Recommendation 5.0 (patients with poor prognosis)

Recommendation 5.1

Recommendation 6.0 (patients with intracranial metastases which progress despite initial therapy)

Recommendation 6.1 (brain recurrence and prior WBRT; limited recurrenceb)

Recommendation 6.2 (diffuse recurrencec)

Recommendation 6.3 (diffuse recurrencec)

Systemic Therapy

Recommendation 7.1

Recommendation 8.1 (brain recurrence and systemic therapy)

Recommendation 8.2

Recommendation 9.1

Screening

Recommendation 10.1 (screening)

Recommendation 10.2

Recommendation Grading

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology

Recommendation 2.1. (single brain metastasis, favorable prognosis^a)

Diffuse Disease or Extensive Metastases^c

Recommendation 6.1 (brain recurrence and prior WBRT; limited recurrence^b)

Recommendation 6.2 (diffuse recurrence^c)

Recommendation 6.3 (diffuse recurrence^c)