Breast cancer is the most frequently diagnosed neoplasm all over the world and the second leading cause of cancer death in women. Breast cancer prognosis has significantly improved in the last years due to the advent of novel therapeutic options, both in the early and in advanced stages. However, the spread of the disease to the brain, accounting for 15–30% of the metastatic diagnoses, is challenging, and its poor prognosis represents an unmet medical need, leading to deterioration of quality of life and causing morbidity and mortality. Generally, triple-negative and HER2-positive breast cancer subtypes more frequently spread to the brain or in the leptomeningeal space. Consequently, according to international guidelines, several systemic treatments can be offered as a first option in some subsets of patients. However, a multidisciplinary approach is recommended to offer the most appropriate strategy to patients. Antibody–drug conjugates such as trastuzumab deruxtecan or sacituzumab govitecan along with small molecules have led to important achievements in the treatment of brain metastases from HER2-positive and triple-negative breast cancer. In this narrative review, we will focus on the molecular features leading to the development of brain metastases and explore the risk and the prognostic factors involved in the development of brain metastases. Finally, we will review the major achievements in the treatment landscape of brain metastases from breast cancer and novel medical approaches.
乳腺癌是全球范围内最常被诊断的肿瘤，也是女性癌症死亡的第二大原因。近年来，由于早期和晚期阶段新型治疗方案的问世，乳腺癌的预后已显著改善。然而，该疾病向脑部的扩散（占转移性诊断的15-30%）仍具有挑战性，其不良预后代表了尚未满足的医疗需求，导致生活质量恶化并引发发病率和死亡率。通常，三阴性及HER2阳性乳腺癌亚型更常扩散至脑部或软脑膜间隙。因此，根据国际指南，在某些患者亚群中，多种全身性治疗可作为首选方案。然而，建议采用多学科方法为患者提供最合适的治疗策略。抗体药物偶联物（如曲妥珠单抗德鲁替康或沙西妥珠单抗戈维替康）以及小分子药物在治疗HER2阳性和三阴性乳腺癌脑转移方面取得了重要进展。在本叙述性综述中，我们将重点关注导致脑转移发生的分子特征，探讨脑转移发展过程中的风险及预后因素，并回顾乳腺癌脑转移治疗领域的主要成果及新型医学方法。
肿瘤(癌症)患者之家