Update!

After an expert panel perused 662 relevant publications from 2012-2017, the big update in the latest published ASCO guidelines on the management of HER2(+) breast cancer metastatic to the brain is that there is no update. As in the 2014 guidelines, laissez faire direction on optimal local treatment of brain mets in this setting remains, in summary, anything goes. Including any combo of resection, radiosurgery, whole brain radiation, and best supportive care. But there are two important points worth noting: [1] they continue to recommend against any form of brain MRI surveillance without known brain mets or neurologic symptoms, and [2] systemic therapy should not be switched for isolated intracranial progression in the absence of systemic progression. TBL: Keep treating brain mets from HER2(+) breast cancer like you already are, with some line of HER2-targeted systemic therapy and selection of local treatment modality based on intracranial disease burden and life expectancy. | Ramakrishna, J Clin Oncol 2018