Novel treatment strategies and key research priorities for patients with breast cancer and central nervous system (CNS) metastases

Despite improvements in surgical techniques, advances in delivery of radiation therapy, and development of therapies with central nervous system (CNS) activity, the presence of CNS metastases from breast cancer is frequently associated with a poor prognosis. In 2023, the leadership of the Breast International Group and National Cancer Institute's National Clinical Trials Network convened a CNS working group to identify key challenges and discuss ways that international collaborations could push forward progress in the field. This review reflects initial discussions of the working group and addresses (1) the possible role of screening for CNS metastases, (2) optimal sequencing of local and systemic therapies among patients with human epidermal growth factor receptor 2 (HER2)-positive CNS metastases, (3) management of leptomeningeal disease, and (4) the importance of developing innovative clinical trials for treatment and prevention of CNS metastases across breast cancer subtypes that is informed by preclinical data/basic science, with seamless knowledge translation to allow for rapid clinical adoption.