Treatments for primary breast cancer have improved over the past two decades. However, brain metastases (BM) still kill a high number of patients with HER2-positive and triple negative breast cancer.

Fortunately, treatments for BM have improved rapidly with the use of fractionated stereotactic radiosurgery, targeted therapies and immunotherapies. Importantly, we have a growing understanding of the biological processes of breast cancer BM (BCBM).

Treatment strategies for BCBM continue to increase with exploitation of the molecular characterization of BCBM tumors and their interactions with the brain microenvironment. Repositioned drugs that target BCBM can be tested more rapidly in patients and are showing promise. Advances in minimally invasive neurosurgery and stereotactic radiotherapy refine the localization of treatment, improving survival and quality of life for patients with BCBM.

More and more options are becoming available in the fight against BCBM. In this review in Therapeutic Advances in Medical Oncology, our specialists in oncology and neurosurgery describe recent clinical treatment options and experimental therapeutic strategies that have the potential to combat BCBM, including targeting tumor-neural microenvironments, targeted therapies primarily for HER2-positive BCBM, immunotherapy, minimally invasive neurosurgery and clinical radiotherapy.