[Debbie L.]

Thanks as always, Lani. This is interesting, and timely for another thread, Catherine's about standard follow-up and tumor markers, where there's a sub-thread about tumor markers and brain mets.

This study did not, however, compare PET/MRI to simple brain MRI. It was looking at whole body PET/CT vs PET/MRI, right? Is it possible (even likely) that a basic brain MRI could do as well as a PET/MRI, for detecting brain mets?

I'm glad that they are looking at ways to detect brain mets as soon as possible, because as you say, treatment can be less invasive when brain mets are small. But I can't help but wonder where this will take us. Just anecdotally, it seems to me that typical HER2+ brain mets progress quite rapidly. If it was decided, for example, that everyone diagnosed with HER2+ breast cancer should be regularly screened for brain mets -- how often would we have to do that, to make a difference?

I hope that this becomes a moot question. That we find a treatment that, ideally, prevents brain mets, or at least treats them systemically, with fewer toxicities (there is a study in the works using temozolomide for prevention). And I'd have to add that as I've seen it, one of the biggest downsides for some people is the side effects of the steroids, and the weaning from them.

Debbie Laxague