Breast cancer, CNS metastases

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Section editor
Gayathri Nagaraj, MD
Loma Linda University
Loma Linda, CA, USA

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Last updated on 2024-07-23:
13 regimens on this page
13 variants on this page

Note: these are studies of regimens tested in patients with breast cancer and CNS metastases, or subgroups of more general studies that focused on patients with CNS metastases. Please see the main breast cancer page for other regimens.


Guidelines

Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.


NCCN


Unselected, all lines of therapy

Docetaxel monotherapy

D: Docetaxel
T: Taxotere (Docetaxel)

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

To be completed

Chemotherapy

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


Eribulin monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

Chemotherapy

21-day cycles

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


Gemcitabine monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

To be completed

Chemotherapy

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


Ixabepilone monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

Chemotherapy

21-day cycles

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


Paclitaxel monotherapy, weekly

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

To be completed

Chemotherapy

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


nab-Paclitaxel monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

To be completed

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


Vinorelbine monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Tripathy et al. 2022 (ATTAIN) 2017-2019 Phase 3 (C) Etirinotecan pegol Did not meet primary endpoint of OS

To be completed

References

  1. ATTAIN: Tripathy D, Tolaney SM, Seidman AD, Anders CK, Ibrahim N, Rugo HS, Twelves C, Diéras V, Müller V, Du Y, Currie SL, Hoch U, Tagliaferri M, Hannah AL, Cortés J; ATTAIN Investigators. Treatment With Etirinotecan Pegol for Patients With Metastatic Breast Cancer and Brain Metastases: Final Results From the Phase 3 ATTAIN Randomized Clinical Trial. JAMA Oncol. 2022 Jul 1;8(7):1047-1052. link to original article link to PMC article does not contain dosing details PubMed NCT02915744


HER2-positive, first-line therapy

Capecitabine & Lapatinib

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Pivot et al. 2015 (CEREBEL) 2009-2012 Phase 3 (E-switch-ic) Capecitabine & Trastuzumab Did not meet primary endpoint of CNS metastases as first site of relapse

Biomarker eligibility criteria

  • Gene: HER2 Positive
  • Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization

Chemotherapy

Targeted therapy

21-day cycles

References

  1. CEREBEL: Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00820222


Capecitabine & Trastuzumab (XH)

XH: Xeloda (Capecitabine) & Herceptin

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Pivot et al. 2015 (CEREBEL) 2009-2012 Phase 3 (C) Capecitabine & Lapatanib Did not meet primary endpoint of CNS metastases as first site of relapse

Biomarker eligibility criteria

  • Gene HER2 Positive
  • Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization

Chemotherapy

Targeted therapy

21-day cycles

References

  1. CEREBEL: Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00820222


HER2-positive, subsequent lines of therapy

Capecitabine & Lapatinib

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Pivot et al. 2015 (CEREBEL) 2009-2012 Phase 3 (E-switch-ic) Capecitabine & Trastuzumab Did not meet primary endpoint of CNS metastases as first site of relapse

Biomarker eligibility criteria

  • Gene: HER2 Positive
  • Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization

Chemotherapy

Targeted therapy

21-day cycles

References

  1. CEREBEL: Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. link to original article PubMed NCT00820222


Capecitabine & Trastuzumab (XH)

XH: Xeloda (Capecitabine) & Herceptin

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Pivot et al. 2015 (CEREBEL) 2009-2012 Phase 3 (C) Capecitabine & Lapatanib Did not meet primary endpoint of CNS metastases as first site of relapse

Biomarker eligibility criteria

  • Gene HER2 Positive
  • Clinical Trial Eligibility: score > 2.2 by fluorescence in situ hybridization and/or 3+ amplification by immunohistochemistry or chromogenic/silver in situ hybridization

Chemotherapy

Targeted therapy

21-day cycles

References

  1. CEREBEL: Pivot X, Manikhas A, Żurawski B, Chmielowska E, Karaszewska B, Allerton R, Chan S, Fabi A, Bidoli P, Gori S, Ciruelos E, Dank M, Hornyak L, Margolin S, Nusch A, Parikh R, Nagi F, DeSilvio M, Santillana S, Swaby RF, Semiglazov V. CEREBEL (EGF111438): A phase III, randomized, open-label study of lapatinib plus capecitabine versus trastuzumab plus capecitabine in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer. J Clin Oncol. 2015 May 10;33(14):1564-73. Epub 2015 Jan 20. link to original article dosing details in abstract have been reviewed by our editors PubMed NCT00820222


Capecitabine & Trastuzumab (XH) & Tucatinib

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Murthy et al. 2019 (HER2CLIMB) 2016-2019 Phase 3 (E-RT-esc) XH Superior OS (secondary endpoint)
Median OS: 21.9 vs 17.4 mo
(HR 0.66, 95% CI 0.50-0.88)

Chemotherapy

Targeted therapy

21-day cycles

References

  1. HER2CLIMB: Murthy RK, Loi S, Okines A, Paplomata E, Hamilton E, Hurvitz SA, Lin NU, Borges V, Abramson V, Anders C, Bedard PL, Oliveira M, Jakobsen E, Bachelot T, Shachar SS, Müller V, Braga S, Duhoux FP, Greil R, Cameron D, Carey LA, Curigliano G, Gelmon K, Hortobagyi G, Krop I, Loibl S, Pegram M, Slamon D, Palanca-Wessels MC, Walker L, Feng W, Winer EP. Tucatinib, Trastuzumab, and Capecitabine for HER2-Positive Metastatic Breast Cancer. N Engl J Med. 2020 Feb 13;382(7):597-609. Epub 2019 Dec 11. Erratum in: N Engl J Med. 2020 Feb 6;382(6):586. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT02614794
    1. Subgroup analysis: Lin NU, Borges V, Anders C, Murthy RK, Paplomata E, Hamilton E, Hurvitz S, Loi S, Okines A, Abramson V, Bedard PL, Oliveira M, Mueller V, Zelnak A, DiGiovanna MP, Bachelot T, Chien AJ, O'Regan R, Wardley A, Conlin A, Cameron D, Carey L, Curigliano G, Gelmon K, Loibl S, Mayor J, McGoldrick S, An X, Winer EP. Intracranial Efficacy and Survival With Tucatinib Plus Trastuzumab and Capecitabine for Previously Treated HER2-Positive Breast Cancer With Brain Metastases in the HER2CLIMB Trial. J Clin Oncol. 2020 Aug 10;38(23):2610-2619. Epub 2020 May 29. link to original article link to PMC article PubMed


Trastuzumab deruxtecan monotherapy

Regimen

Study Dates of enrollment Evidence Comparator Comparative Efficacy
Cortés et al. 2022 (DESTINY-Breast03) 2018-2020 Phase 3 (E-RT-switch-ic) T-DM1 Superior PFS1 (primary endpoint)
Median PFS: 15 vs 3 mo
(HR 0.25, 95% CI 0.13-0.45)

1Reported efficacy is based on the 2024 subgroup analysis of patients with brain metastases.

Prior treatment criteria

  • DESTINY-Breast03: Trastuzumab and taxane

Antibody-drug conjugate therapy

21-day cycles

References

  1. DESTINY-Breast03: Cortés J, Kim SB, Chung WP, Im SA, Park YH, Hegg R, Kim MH, Tseng LM, Petry V, Chung CF, Iwata H, Hamilton E, Curigliano G, Xu B, Huang CS, Kim JH, Chiu JWY, Pedrini JL, Lee C, Liu Y, Cathcart J, Bako E, Verma S, Hurvitz SA; DESTINY-Breast03 Trial Investigators. Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer. N Engl J Med. 2022 Mar 24;386(12):1143-1154. link to original article dosing details in manuscript have been reviewed by our editors PubMed NCT03529110
    1. Update: Hurvitz SA, Hegg R, Chung WP, Im SA, Jacot W, Ganju V, Chiu JWY, Xu B, Hamilton E, Madhusudan S, Iwata H, Altintas S, Henning JW, Curigliano G, Perez-Garcia JM, Kim SB, Petry V, Huang CS, Li W, Frenel JS, Antolin S, Yeo W, Bianchini G, Loi S, Tsurutani J, Egorov A, Liu Y, Cathcart J, Ashfaque S, Cortés J. Trastuzumab deruxtecan versus trastuzumab emtansine in patients with HER2-positive metastatic breast cancer: updated results from DESTINY-Breast03, a randomised, open-label, phase 3 trial. Lancet. 2023 Jan 14;401(10371):105-117. Epub 2022 Dec 7. link to original article PubMed
    2. PRO analysis: Curigliano G, Dunton K, Rosenlund M, Janek M, Cathcart J, Liu Y, Fasching PA, Iwata H. Patient-reported outcomes and hospitalization data in patients with HER2-positive metastatic breast cancer receiving trastuzumab deruxtecan or trastuzumab emtansine in the phase III DESTINY-Breast03 study. Ann Oncol. 2023 Jul;34(7):569-577. Epub 2023 May 12. link to original article PubMed
    3. Subgroup analysis: Hurvitz SA, Kim SB, Chung WP, Im SA, Park YH, Hegg R, Kim MH, Tseng LM, Petry V, Chung CF, Iwata H, Hamilton E, Curigliano G, Xu B, Egorov A, Liu Y, Cathcart J, Bako E, Tecson K, Verma S, Cortés J. Trastuzumab deruxtecan versus trastuzumab emtansine in HER2-positive metastatic breast cancer patients with brain metastases from the randomized DESTINY-Breast03 trial. ESMO Open. 2024 May;9(5):102924. Epub 2024 Apr 24. link to original article link to PMC article PubMed