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From the Brain Tumor Institute,* Cleveland Clinic Foundation, Cleveland, Ohio; the Women’s Cancer Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and the Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
Abstract
Clinically symptomatic metastases to the central nervous system (CNS) occur in 
10 to 15% of patients with metastatic beast cancer. CNS metastases are traditionally viewed as a late complication of systemic disease, for which few effective treatment options exist. Recently, patients with Her-2-positive breast tumors who were treated with trastuzumab have been reported to develop CNS metastases at higher rates, often while responding favorably to treatment. The blood:brain barrier and the unique brain microenvironment are hypothesized to promote distinct molecular features in CNS metastases that may require tailored therapeutic approaches. New research approaches using cell lines that reliably and preferentially metastasize in vivo to the brain have been reported. Using such model systems, as well as in vitro analogs of blood-brain barrier penetration and tissue-based studies, new molecular leads into this disease are unfolding.
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