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Narrative Review of Multidisciplinary Management of Central Nervous Involvement in Patients with HER2-Positive Metastatic Breast Cancer: Focus on Elderly Patients

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Abstract

The tumor biology of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) promotes the development of central nervous system (CNS) metastases, with 25% of patients with HER2-positive BC developing CNS metastases. Furthermore, the incidence of HER2-positive BC brain metastases has increased in the last decades, likely because of the improved survival with targeted therapies and better detection methods. Brain metastases are detrimental to quality of life and survival and represent a challenging clinical problem, particularly in elderly women, who comprise a substantial proportion of patients diagnosed with BC and often have comorbidities or an age-related decline in organ function. Treatment options for patients with BC brain metastases include surgical resection, whole-brain radiation therapy, stereotactic radiosurgery, chemotherapy, and targeted agents. Ideally, local and systemic treatment decisions should be made by a multidisciplinary team, with input from several specialties, based on an individualized prognostic classification. In elderly patients with BC, additional age-associated conditions, such as geriatric syndromes or comorbidities, and the physiologic changes associated with aging, may impact their ability to tolerate cancer therapy and should be considered in the treatment decision-making process. This review describes the treatment options for elderly patients with HER2-positive BC and brain metastases, focusing on the importance of multidisciplinary management, the different points of view from the distinct disciplines, and the role of oncogeriatric and palliative care in this vulnerable patient group.

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Acknowledgements

Funding

Medical writing assistance for this mansucript and the Rapid Service Fee were funded by Roche Farma S.A.

Medical Writing, Editorial, and Other Assistance

Medical writing assistance in the preparation of this article was provided by Anabel Herrero and Catherine Rees on behalf of Springer Healthcare Communications. Editorial assistance post submission was provided by Tracy Harrison of Springer Healthcare Communications. Support for editorial assistance was funded by Roche Farma S.A.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

All named authors, Elena Galve-Calvo, Alberto Alonso-Babarro, María Martínez-García, María Pi-Figueras, Gloria Villalba, Saioa Alonso, and Jorge Contreras, contributed to the literature review, evidence selection, drafting and critical revision of the article. All authors read and approved the final manuscript for publication.

Disclosures

Elena Galve reports personal fees and non-financial support from AstraZeneca, Novartis, Roche Farma, and Pfizer; and personal fees from Celgene and Pierre Fabre, outside the submitted work. Alberto Alonso-Babarro reports other fees from Roche Farma. María Martínez-García reports personal fees and non-financial support from Roche Farma; non-financial support from Pfizer; and personal fees from Celgene and Pierre Fabre, outside the submitted work. María Pi-Figueras reports personal fees and non-financial support from Roche Farma. Gloria Villalba declares no competing interests. Saioa Alonso was an employee of Roche Farma, Spain during the preparation of this manuscript, she is currently an employee of AstraZeneca. Jorge Contreras reports personal fees from Roche and Merck.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Data Availability

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Authors and Affiliations

  1. Medical Oncology Service, Hospital Universitario Basurto (OSI Bilbao-Basurto), Avda. Montevideo 18, 48013, Bilbao, Bisczy, Spain

    Elena Galve-Calvo

  2. Palliative Care Department, Hospital La Paz, Madrid, Spain

    Alberto Alonso-Babarro

  3. Medical Oncology Department, Hospital Del Mar, Barcelona, Spain

    María Martínez-García

  4. Geriatrics Service, Hospital del Mar, Barcelona, Spain

    María Pi-Figueras

  5. Neurosurgery Service, Hospital del Mar, Barcelona, Spain

    Gloria Villalba

  6. Roche Farma S.A., Madrid, Spain

    Saioa Alonso

  7. Radiation Oncology Department, Hospital Carlos Haya, Málaga, Spain

    Jorge Contreras

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Correspondence to Elena Galve-Calvo.

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Galve-Calvo, E., Alonso-Babarro, A., Martínez-García, M. et al. Narrative Review of Multidisciplinary Management of Central Nervous Involvement in Patients with HER2-Positive Metastatic Breast Cancer: Focus on Elderly Patients. Adv Ther 40, 3304–3331 (2023). https://doi.org/10.1007/s12325-023-02538-6

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