Managing Side Effects for Brain Metastasis in HER2+ Breast Cancer

Dr. Vikram C. Gorantla, a medical oncologist at University of Pittsburgh Medical Center, discusses key considerations for patients with brain metastases due to their HER2-positive breast cancer. Gorantla shared his insights during a live interview with CURE at the 2025 San Antonio Breast Cancer Symposium (SABCS).

During the discussion, he emphasized that it is important for patients to know that maintaining their overall health, including nutrition and wellness, is critical to handling treatment side effects. Patients receiving Enhertu (fam-trastuzumab deruxtecan-nxki; T-DXd) may experience nausea and fatigue, with a small risk of pneumonitis, while tucatinib-based therapy can cause rash and diarrhea.

Gorantla highlights that managing these side effects effectively allows patients to remain on therapy, supporting better outcomes and quality of life.

Transcript

How does a patient’s overall health or lifestyle affect their ability to tolerate breast cancer therapy? What should patients keep in mind to help stay on therapy?

Overall, taking care of your health matters, right? It helps you handle these treatments. These are therapies that each have their own side effect profiles. You need to take care of yourself and ensure your nutrition is up to speed to manage the side effects of these drugs. For example, T-DXd is given every three weeks and can cause nausea and fatigue. We also watch for the very small risk of pneumonitis, but the main side effects are nausea and fatigue.

It’s important to manage these side effects well to stay on therapy. Other drugs, like Xeloda (capecitabine), Tukysa (tucatinib), and Herceptin (trastuzumab), have different profiles, the main side effects being rash and diarrhea, so you need to be able to handle them.

Ultimately, it really comes down to your overall health. If you are taking care of yourself and living the best life you can with this cancer, these treatments can help extend that life.

Transcript has been edited for clarity and conciseness.

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