Metastatic Her2 enriched breast cancer on treatment

A lady aged 37 with Her-2 enriched breast cancer diagnosed in 2017.....was treated with 3 cycles of NACT followed by mastectomy and adjuvant chemo... Also received 10 cycles of trastuzumab in adjuvant setting. After tenth cycle she was diagnosed to have cerebellar mets... Had craniotomy and resection followed by brain RT. Now on Lapatinib. Asymptomatic We don't have any baseline CA15-3 to monitor disease. Has completed more than 2 years of Lapatinib..... Most troublesome toxicity has been financial. She is unlikely to continue Lapatinib because of cost. What are the possible alternatives?



Question- Single or multiple metastasis brain Mets? Is she is CR now (CNS and body). If the patient is unable to afford and in CR, Waitful watching with close imaging follow-up is what I would recommend. If on follow up small CNS Mets pop up then you can do Gamma-knife or restart lapatinib+ Capecitabine or Tucatinib based combination (DESTINY trial). If body disease relapses, many options available now.

Is it HER2+/HR- or HER2+/HR+

Her tumor is Hormone receptor negative. She is in CR.. Both CNS and otherwise.

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