{"entity":{"id":"her2-brain-metastases","kind":"term","name":"HER2-positive brain metastases","aka":[],"tldr":"Up to half of women with metastatic HER2-positive breast cancer develop brain metastases, because antibodies control the body but historically not the brain.","summary":"Incidence 30-50% in metastatic HER2+ disease. Local therapy (radiosurgery, surgery, whole-brain RT) was the mainstay; tucatinib (HER2CLIMB: CNS-PFS HR 0.32) and T-DXd (DESTINY-Breast12: intracranial ORR 71.7%) now provide systemic control, allowing deferral of radiation in selected patients. Neratinib and pyrotinib have modest CNS activity.","asOf":"2026-09-07","wikipedia":"https://en.wikipedia.org/wiki/Brain_metastasis","links":[{"label":"ClinicalTrials.gov NCT02614794: HER2CLIMB","url":"https://clinicaltrials.gov/study/NCT02614794"},{"label":"ClinicalTrials.gov NCT04739761: DESTINY-Breast12","url":"https://clinicaltrials.gov/study/NCT04739761"}],"tags":[],"related":[],"cancers":["breast-her2-positive"],"sections":[],"technologies":["sbrt","mri"],"targets":[],"drugs":["tucatinib","trastuzumab-deruxtecan","neratinib"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["her2climb","destiny-breast12"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Clinical"},"route":"/terms/her2-brain-metastases/","neighbours":{"cancer":[{"id":"secondary-brain-tumours","kind":"cancer","name":"Brain metastases (secondary brain tumours)","route":"/cancers/secondary-brain-tumours/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"her2-positive-breast-brain-metastases","kind":"cancer","name":"HER2-positive breast cancer with brain metastases","route":"/cancers/her2-positive-breast-brain-metastases/"}],"technology":[{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"}],"drug":[{"id":"neratinib","kind":"drug","name":"Neratinib","route":"/drugs/neratinib/"},{"id":"trastuzumab-deruxtecan","kind":"drug","name":"Trastuzumab deruxtecan","route":"/drugs/trastuzumab-deruxtecan/"},{"id":"tucatinib","kind":"drug","name":"Tucatinib","route":"/drugs/tucatinib/"}],"trial":[{"id":"destiny-breast12","kind":"trial","name":"DESTINY-Breast12","route":"/trials/destiny-breast12/"},{"id":"her2climb","kind":"trial","name":"HER2CLIMB","route":"/trials/her2climb/"}],"pairing":[{"id":"tucatinib-triplet-brain-mets","kind":"pairing","name":"Tucatinib + trastuzumab + capecitabine for brain metastases","route":"/pairings/tucatinib-triplet-brain-mets/"}],"idea":[{"id":"idea-bio2-intraventricular-car-t","kind":"idea","name":"Deliver CAR-T cells straight into the fluid around the brain","route":"/ideas/idea-bio2-intraventricular-car-t/"},{"id":"idea-bio2-brain-met-prevention-trials","kind":"idea","name":"Prevention trials aimed only at brain metastasis","route":"/ideas/idea-bio2-brain-met-prevention-trials/"},{"id":"idea-bio2-cns-cohort-mandate","kind":"idea","name":"Stop excluding brain metastases from cancer trials","route":"/ideas/idea-bio2-cns-cohort-mandate/"},{"id":"idea-cns-first-adc-strategy","kind":"idea","name":"Systemic-first management of HER2-positive brain metastases","route":"/ideas/idea-cns-first-adc-strategy/"},{"id":"idea-bio2-transferrin-shuttle-adc","kind":"idea","name":"Use the brain's own transport door to carry antibody drugs across","route":"/ideas/idea-bio2-transferrin-shuttle-adc/"}],"bottleneck":[{"id":"b-brain-delivery","kind":"bottleneck","name":"The brain: barrier and sanctuary","route":"/bottlenecks/b-brain-delivery/"}],"pathway":[{"id":"organ-tropism-seed-soil","kind":"pathway","name":"Organ tropism: seed and soil","route":"/pathways/organ-tropism-seed-soil/"},{"id":"blood-brain-barrier-metastasis","kind":"pathway","name":"The blood-brain barrier & brain metastasis","route":"/pathways/blood-brain-barrier-metastasis/"}]}}