Hello,

there are international consensus guidlines for advanced (metastasized) breast cancer, you can find an overview in this publication:

https://doi.org/10.1093/annonc/mdw544

So a hospital working according to this guidelines will provide state of the art treatment. For brain metastases radiation(-surgery) therapy is helpful in many cases, depending on the size and the region of the metastases. You can find some information in this review:

https://www.ncbi.nlm.nih.gov/pubmed/27649142

Also genetic testing has made its way into the clinic. Some bigger (university) hospitals routinely perform NGS diagnostics, this might be done in the context of clinical studies. There are seven cancer centers which joined up to better use the results of this efforts, you can find an overview under this link:

http://www.aacr.org/Documents/GENIE_InfoGraph.pdf

There are also commercial NGS tests available, but you will always need a specialized doctor who interpretes the results and guide you through a decision finding process.

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Secondary Brain deposits is a common issue of many malignancies, among it, Breast cancers, long ago they pointed HER2 positive tumors receving specific therapy had higher incidence of brain mts. ESMO, ASCO, NCCN, have guidelines about CNS lumps, from the references, you can locate centers having an experience large enough in Breast ca Brain mts, many therapies exist, from hormones in some HR positive cases, several types of blood brain barrier crossing drugs, and barrier is altered when mts exist, IMRT, Tomotherapy, 'Gamma knife', intra-thecal or intra-cisternal anti-HER2 MoAbs,...

You're not alone!

I wish a good outcome to your case, regards, + Salud 

Thank you very much Tobias, Igor and Joe for your replies. What I know is that there is no cure for brain cancer metastasized from breast cancer. The treatment that is used in the case I am asking about is Herceptin (Her2-+ve), Femara (estrogen, Progesterone +ve) and sterostatic  radiation (for brain metastasis). I am wondering if there is a new treatment drug that can cross the brain barrier to be used for brain metastasis treatment. As I know, there is a drug that can cross the blood brain barrier but it used only for primary brain cancer; I don't know why not for metastasis too.

Perhaps a simple Methotrexate may work, but there are many publications about the subject, An Entrez PubMed query with the search term: 'her 2 positive breast cancer brain metastasis treatment', yielded 115 references...

Dear Esmahan,

I would start by Memorial Sloan Kettering , MD Anderson or Dana Farber cancer centers. Yes guidelines are the same everywhere but practices are different from a cancer center to another.

Best of luck.

https://doi.org/10.1093/annonc/mdw544

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God bless you!

Thanks again Joe for your effort and for sending me all these links. That's very kind of you.

Thanks too to Sihem. I agree with you and I started with these centers. I was looking if they have clinical trials for this case. Unfortunately, I didn't find any trial including ARC with metastasis in liver and brain, in Her2+ve, estrogen, Progesterone +ve. There is clnical trials for only separate cases.

Thanks again for all

There are publications about Breast cancer liver deposits for all subtypes of tumors, I'd say the main issue to consider is CNS, death because of liver lesions tends being connected to deposits representing more than a certain % of liver mass, the true liver tissue enters apoptosis, and death comes from the toxic state, usually along with estupor-coma.

Hope everything goes well.

Regards, + Salut 

In our center we have good experience in that setting. Actually we are preparing a paper for publication with more than 250 cases. 

Lapatinib (Tykerb) is an option for metastatic breast cancer patients who have failed taxane, anthracycline and Trastuzumab (Herceptin); where it is given with capecitabine. 

It's also used in hormone positive patients in combination therapy with Letrozole (Femara).

Lapatinib works better if given concomitantly with another anti-Her2 agent, as single drug, results are not that good.

Nobody said that, Lapatinib is given as a single agent!! It's licensed to be given in combination with either Capecitabine or Trastuzumab (Herceptin).

In the case of hormone receptor positive and Her2 over-expression advanced breast cancer, Lapatinib is also LICENSED to be given in combination therapy with Letrozole (Femara) for postmenopausal women. 

Thanks a lot Khaled and Joe for your answers. I am looking for a treatment for breast Ca (Her 2 +ve, ER, PR +ve)  that metastasized to liver and brain after 13 years. The first time (13 years ago), surgery and chemotherapy (Taxane) was given, with Femara and Herceptin. After metastasis, Treatment with Herceptin and Femara stabilized the liver. For brain, intensive (for 15 minutes)  stereostatic surgery was done for 4 sessions Dec 26- Jan 6. Waiting for check up with MRI. The problem this will not be a cure for the brain metastasis. I am looking for a new cure or clinical trial that deals with similar cases. I searched clinical trials. gov but didn't find any for this special case. I learnt that marijuana oil is effective against brain cancer but I don't know the dose, how it can be used: local application or by ingestion and what is the dose. I read also about some mushrooms (riki, turkey tail, shitake) that helped patients to boost immune system but I am afraid the use of any of these might interfere with the treatment of brain. I know these will not cure neither, but might help boost the immune system. The doctor now wants to include chemotherapy to the treatment, so boosting immune system is needed now.

Thanks a lot Paula. I would love to see your paper when it is published.