Key Points

Local Therapy

Systemic Therapy

Screening

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

Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer – Brain Metastases

American Society of Clinical Oncology

Publication Date: May 31, 2022

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

Abbreviations

ASCO: American Society of Clinical Oncology

BSC: best supportive care

cm: centimeters

CNS: central nervous system

HA: hippocampal avoidance

HER2: Human Epidermal Growth Factor Receptor 2

HSRT: hypofractionated stereotactic radiotherapy

KPS: Karnofsky Performance Status

M: memantine

MDT: multidisciplinary team

MRI: magnetic resonance imaging

RT: radiation therapy

SRS: stereotactic radiosurgery

WB: whole-brain radiation therapy

WBRT: whole-brain radiotherapy

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.

Disclaimer

This pocket guide is derived from recommendations in the American Society of Clinical Oncology Guideline. This resource is a practice tool based on ASCO® practice guidelines and is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines do not account for individual variation among patients. This pocket guide does not purport to suggest any particular course of medical treatment. Use of the practice guidelines and this resource are voluntary. The practice guidelines and additional information are available at www.asco.org/breast-cancer-guidelines. Copyright © 2022 by American Society of Clinical Oncology. All rights reserved.

Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer – Brain Metastases

Key Points

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

Figure 1. Algorithm for Patients with HER2+ Metastatic Breast Cancer with CNS Metastasis

Recommendation Grading

Abbreviations

Source Citation

Disclaimer

Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer – Brain Metastases

Key Points

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

Figure 1. Algorithm for Patients with HER2+ Metastatic Breast Cancer with CNS Metastasis

Recommendation Grading

Abbreviations

Source Citation

Disclaimer

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)