ESMO 2026 | Intrathecal trastuzumab and pertuzumab for HER2+ leptomeningeal metastasis
Kamran Ahmed, MD, Moffitt Cancer Center, Tampa, FL, discusses the emerging clinical challenge of leptomeningeal and brain metastases in patients with improved systemic breast cancer control, particularly in the HER2-positive setting. Intrathecal trastuzumab and pertuzumab represent a regimen to be considered for managing HER2-positive leptomeningeal metastases, and the combination of systemic agents with intracranial activity and local therapies such as radiotherapy are improving outcomes for these patients. This interview took place at the European Society for Medical Oncology (ESMO) 2026 Congress in Madrid, Spain.
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So you know, we’re seeing with improved systemic control, we are seeing a lot more patients now living with leptomeningeal metastasis as well as brain metastases. And so intrathecal trastuzumab and pertuzumab, I think, is a regimen that should be considered in the management of HER2-positive leptomeningeal metastases. Many of our patients on the study had progressed past through tucatinib, zolota, and Herceptin, as well as TDXD. And many patients also continued that while having progression in the leptomeninges for systemic control. So I think certainly intrathecal trastuzumab pertuzumib should be considered in patients, you know, to manage the progression in the lepomeningeas. Yeah. So I think with improved systemic control, we’re seeing, you know, more isolated progression within the central nervous system. So more patients who are living longer with brain metastasis as well as leptomeningeal metastases. And it’s exciting to see, you know, more data emerging for systemic agents that have intracranial control. And so I think in combination with local therapies like radiation therapy, we’re seeing improved outcomes for these patients.
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