This episode addresses central nervous system metastases, which the panel notes may affect nearly half of patients with HER2-mutant non–small cell lung cancer. Faculty stress baseline brain MRI for every patient with metastatic disease and describe a framework built on symptom status. Symptomatic lesions warrant referral to radiation oncology or neurosurgery, while small, asymptomatic lesions without edema may be observed on zongertinib, with an early repeat brain MRI rather than waiting for the standard restaging interval. The panel reports meaningful intracranial responses among patients with active, untreated brain metastases in the trial setting. For patients without baseline brain involvement, periodic surveillance MRI is described. The discussion closes on progression: isolated central nervous system progression with systemic control may be managed with stereotactic radiation while continuing therapy, and rebiopsy of accessible lesions may reveal new driver alterations that inform the next treatment decision.
