Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood–brain barrier. While radiotherapy is still fundamental in local therapy, its use is associated with cognitive adverse effects and limited long-term control, necessitating the exploration of alternative treatments. Targeted therapies, including tyrosine kinase inhibitors, monoclonal antibodies, and antibody–drug conjugates, offer promising options for HER2+ breast cancer patients with BM. Clinical trials have demonstrated the efficacy of these agents in controlling tumor growth and improving patient outcomes, posing the question of whether radiotherapy is always the unique choice in treating this cancer. Ongoing research into novel anti-HER2 antibodies and innovative combination therapies holds promise for advancing treatment outcomes and enhancing patient care in this clinical scenario. This narrative review provides a comprehensive overview of traditional medical treatments, molecularly targeted therapy and investigational agents in the management of HER2+ breast cancer with BM, highlighting the evolving landscape and potential future directions in treatment strategies to improve patient survival and quality of life.
脑转移（BM）是HER2阳性乳腺癌治疗中的重大挑战，约50%的HER2阳性乳腺癌患者会发生脑转移。脑转移的复杂过程涉及基因突变、适应性改变以及突破血脑屏障的多种机制。虽然放疗仍是局部治疗的基石，但其应用常伴随认知功能损害等不良反应，且长期控制效果有限，因此亟需探索替代治疗方案。针对HER2阳性乳腺癌脑转移患者，以酪氨酸激酶抑制剂、单克隆抗体和抗体偶联药物为代表的靶向治疗展现出广阔前景。临床试验已证实这些药物在控制肿瘤生长和改善患者预后方面的疗效，这引发了关于放疗是否仍是此类癌症唯一治疗选择的思考。当前针对新型抗HER2抗体及创新联合疗法的研究，有望推动该临床领域的治疗进展并提升患者照护水平。本综述系统阐述了HER2阳性乳腺癌脑转移的传统药物治疗、分子靶向治疗及在研新药，着重探讨了治疗策略的发展趋势与未来方向，以期为改善患者生存率和生活质量提供参考。
肿瘤(癌症)患者之家