2014年，美国临床肿瘤学会（ASCO）首次发布HER2阳性晚期乳腺癌脑转移患者疾病治疗推荐意见，并于2018年对该推荐意见进行更新，至今又隔4年。
2022年5月31日，ASCO《临床肿瘤学杂志》在线发表佛罗里达大学奥兰多医院癌症研究所、杜克大学、哈佛大学达纳法伯癌症研究所、密歇根大学、安娜堡患者权益基金会、ASCO、纽约纪念医院斯隆凯特林癌症中心、纽约州中部血液病与肿瘤医院、西雅图癌症医疗联盟、华盛顿大学弗雷德哈钦森癌症研究中心、德克萨斯肿瘤医院、德克萨斯大学MD安德森癌症中心、法国古斯塔夫·鲁西研究所联合起草的HER2阳性晚期乳腺癌脑转移治疗：ASCO指南更新。
为了更新来自临床证据和专家共识的指南推荐意见，供临床肿瘤科医师治疗HER2阳性晚期乳腺癌脑转移患者，专家组针对全身治疗±中枢神经系统转移截至2021年发表的文献进行系统回顾，确定545篇文献，关注的结局包括总生存、无进展生存和不良事件。
结果，从545篇文献筛选出6篇关于全身治疗的文献，作为中枢神经系统转移全身治疗指南推荐意见的证据基础，主要推荐意见如下：
一、如有指征，脑转移患者应该接受适当的局部治疗和全身治疗。
二、局部治疗包括：手术、全脑放疗和立体定向放射手术。
三、如果可能，全脑放疗应该加用美金刚并避开海马体。
四、治疗方法取决于：患者预后、有无症状、能否切除、转移灶数量和大小、既往治疗方法、转移灶是否弥漫等因素。
五、其他选择包括：全身治疗、最佳支持治疗、参加临床试验、姑息治疗。
六、缺乏足够数据推荐或反对常规进行磁共振成像筛查脑转移；由于HER2阳性晚期乳腺癌患者脑转移发生率高，临床医师应该降低脑部磁共振成像的门槛。
相关链接
J Clin Oncol. 2022 May 31. Online ahead of print.
Management of Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases: ASCO Guideline Update.Ramakrishna N, Anders CK, Lin NU, Morikawa A, Temin S, Chandarlapaty S, Crews JR, Davidson NE, Franzoi MAB, Kirshner JJ, Krop IE, Patt DA, Perlmutter J, Giordano SH.Orlando Health Cancer Institute, Orlando, FL; Duke University, Durham, NC; Dana-Farber Cancer Institute, Boston, MA; University of Michigan, Ann Arbor, MI; Patient Advocate, Ann Arbor, MI; American Society of Clinical Oncology, Alexandria, VA; Memorial Sloan Kettering Cancer Center, New York, NY; Hematology/Oncology Associates of Central New York, East Syracuse, NY; Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Texas Oncology, Austin, TX; University of Texas MD Anderson, Houston, TX; Institute Gustave Roussy, Villejuif, France.PURPOSE: To provide updated evidence- and consensus-based guideline recommendations to practicing oncologists and others on the management of brain metastases for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced breast cancer up to 2021.METHODS: An Expert Panel conducted a targeted systematic literature review (for both systemic therapy for non-CNS metastases and for CNS metastases of HER2+ guideline updates) that identified 545 articles. Outcomes of interest included overall survival, progression-free survival, and adverse events.RESULTS: Of the 545 publications identified and reviewed, six on systemic therapy were identified to form the evidentiary basis for the systemic therapy for CNS metastases guideline recommendations.RECOMMENDATIONS: Patients with brain metastases should receive appropriate local therapy and systemic therapy, if indicated. Local therapies include surgery, whole-brain radiotherapy, and stereotactic radiosurgery. Memantine and hippocampal avoidance should be added to whole-brain radiotherapy when possible. Treatments depend on factors such as patient prognosis, presence of symptoms, resectability, number and size of metastases, prior therapy, and whether metastases are diffuse. Other options include systemic therapy, best supportive care, enrollment onto a clinical trial, and/or palliative care. There are insufficient data to recommend for or against performing routine magnetic resonance imaging to screen for brain metastases; clinicians should have a low threshold for magnetic resonance imaging of the brain because of the high incidence of brain metastases among patients with HER2-positive advanced breast cancer.DOI: 10.1200/JCO.22.00520
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