Jerzak KJ, Warner E, Knisely JPS, Sahgal A.
 

 J Clin Oncol. 2025 Aug 13:JCO2500356

Among patients with metastatic lung cancer and melanoma, for whom the lifetime incidence of brain metastases is up to 40% and 80%, respectively, brain imaging surveillance has been adopted into clinical practice guidelines in the absence of randomized clinical trial data. Among patients with metastatic HER2+ or TNBC, 33%-50% will develop brain metastases during their lifetime this is much higher than the approximately 15% lifetime risk of brain metastases generally reported for patients with hormone receptor–positive (HR+)/HER2-negative MBC. The question remains—is a high incidence of brain metastases on its own enough to warrant a generalized brain metastasis surveillance program for patients with MBC, or would one first need to demonstrate net clinical benefit from this practice?