How, if at all, does your systemic therapy management differ between HER2+ breast cancer patients with active CNS metastases compared to those with stable/treated CNS metastases?  

I am more likely to utilize the HER2CLIMB regimen (capecitabine + tucatinib + trastuzumab) in an earlier line of therapy for patients with CNS metastases in general. Currently, my systemic therapy choice does not vary significantly by whether CNS mets are active or stable/treated. However, the DESTI...

For HER2+ breast cancer patients with active CNS metastases, the focus is on using systemic therapies with proven CNS penetration, such as tucatinib combined with trastuzumab and capecitabine or T-DXd, to address both systemic and CNS disease. In contrast, for those with stable or treated CNS metast...