OnCo
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Tucatinib + trastuzumab + capecitabine for brain metastases

The one regimen proven in a randomised trial to help HER2-positive brain metastases, extending survival in those patients by six months.

HER2CLIMB: in patients with brain metastases, CNS-PFS HR 0.32 and OS 18.1 vs 12.0 months; response in untreated and treated lesions. Allows deferral of whole-brain radiation in selected cases.

Rationale
Tucatinib is a small, HER2-selective molecule that crosses the blood-brain barrier; capecitabine adds CNS-active cytotoxic effect; trastuzumab maintains systemic control.
Evidence
Phase 3 (HER2CLIMB) with dedicated CNS analyses.

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