For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?

Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.

Answer from: Medical Oncologist at Community Practice

It is important to maintain curative intent in this situation. Most typically, patients with ER+/HER2+ (or triple positive breast cancer) are the youngest of all patients with ER+ breast cancer (Alqaisi et al BCRT 2014), and while anti-HER2 therapy is key, it is also critical to emphasize the role o...

Answer from: Medical Oncologist at Academic Institution

This is a difficult situation with limited data. In general, I would not recommend chemotherapy, and would recommend endocrine therapy. If on tamoxifen at time of recurrence, I would consider change to AI (with OFS, if pre-menopausal). I personally would not add neratinib as this has not been studie...

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Medical Oncologist at NYU Winthrop Hospital
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For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?

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