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5 treatment settings, 4 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Stereotactic radiosurgery to each lesion, or surgery for a large symptomatic lesion, followed by HER2-directed systemic therapy; whole-brain radiotherapy reserved for many lesions.
A single very high dose, or a few doses, aimed at a small brain or spine target with millimetre precision, replacing whole-brain radiotherapy for most brain metastases.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
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Tucatinib with trastuzumab and capecitabine (HER2CLIMB), which improved survival and delayed brain progression.
A HER2-selective pill that works in the brain, for HER2-positive breast cancer with brain metastases.
The first targeted antibody for a solid tumour (1998), which turned HER2-positive breast cancer from the worst subtype into one of the most treatable.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
OS 21.9 vs 17.4 months, HR 0.66; CNS-PFS HR 0.32.
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Trastuzumab deruxtecan, with intracranial responses in most patients (DESTINY-Breast12), positioned as second-line therapy after DESTINY-Breast03.
Trastuzumab deruxtecan (Enhertu) is the most successful ADC ever. It redefined HER2 by working in tumours with only tiny amounts of the protein, and in 2026 moved into early-stage breast cancer.
CNS ORR 71.7%; 12-month PFS 61.6% in brain-metastasis cohort.
PFS HR 0.33; OS HR 0.64.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Neutropenia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 18% |
| Nausea · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Anaemia · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 7% |
| Fatigue · DESTINY-Breast03/04; all-grade rates ≥20% per label | - | 6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Tucatinib added to trastuzumab and pertuzumab maintenance after induction chemotherapy (HER2CLIMB-05).
A HER2-selective pill that works in the brain, for HER2-positive breast cancer with brain metastases.
The first targeted antibody for a solid tumour (1998), which turned HER2-positive breast cancer from the worst subtype into one of the most treatable.
A second HER2 antibody that binds a different spot from trastuzumab, blocking HER2 from pairing with HER3; together they extended survival by 16 months in CLEOPATRA.
PFS 24.9 vs 16.3 months, HR 0.64.
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Neratinib or lapatinib with capecitabine, trastuzumab emtansine with tucatinib (HER2CLIMB-02), repeat radiosurgery, or a clinical trial.
A pill taken for a year after trastuzumab to further reduce recurrence in HER2-positive, hormone-positive breast cancer, limited by severe diarrhoea.
Lapatinib was the first HER2-blocking pill (2007) and is now mostly a comparator arm and a late-line option, displaced by tucatinib and ADCs.
Capecitabine (Xeloda) is a tablet form of the chemotherapy fluorouracil. It is a backbone of treatment for bowel cancer and a standard option in advanced breast cancer.
Trastuzumab emtansine (Kadcyla, T-DM1) was the first ADC for a solid tumour (2013). It is still standard after surgery for HER2+ breast cancer patients whose tumour did not fully respond to pre-surgery treatment.
PFS 9.5 vs 7.4 months, HR 0.76; OS no benefit.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Thrombocytopenia · KATHERINE (adjuvant) | 29% | 6% |
| Fatigue · KATHERINE (adjuvant) | 50% | - |
| Nausea · KATHERINE (adjuvant) | 42% | - |
| Transaminases increased · KATHERINE (adjuvant) | 32% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.