脑转移 (BM) 对 HER2 乳腺癌的治疗提出了重大挑战，因为近 50% 的 HER2 乳腺癌患者会发展为脑肿瘤。脑转移的复杂过程涉及基因突变、适应和克服血脑屏障的机制。虽然放射治疗仍然是局部治疗的基础，但其使用与认知不良反应和有限的长期控制有关，因此需要探索替代治疗。靶向治疗，包括酪氨酸激酶抑制剂、单克隆抗体和抗体药物偶联物，为患有 BM 的 HER2 乳腺癌患者提供了有希望的选择。临床试验已经证明这些药物在控制肿瘤生长和改善患者预后方面的功效，提出了放疗是否始终是治疗这种癌症的唯一选择的问题。正在进行的新型抗 HER2 抗体和创新联合疗法的研究有望在这种临床情况下改善治疗结果并加强患者护理。这篇叙述性综述全面概述了 BM 治疗 HER2 乳腺癌的传统医学治疗、分子靶向治疗和研究药物，强调了改善患者生存和生活质量的治疗策略的不断发展的前景和潜在的未来方向。

Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood-brain barrier. While radiotherapy is still fundamental in local therapy, its use is associated with cognitive adverse effects and limited long-term control, necessitating the exploration of alternative treatments. Targeted therapies, including tyrosine kinase inhibitors, monoclonal antibodies, and antibody-drug conjugates, offer promising options for HER2+ breast cancer patients with BM. Clinical trials have demonstrated the efficacy of these agents in controlling tumor growth and improving patient outcomes, posing the question of whether radiotherapy is always the unique choice in treating this cancer. Ongoing research into novel anti-HER2 antibodies and innovative combination therapies holds promise for advancing treatment outcomes and enhancing patient care in this clinical scenario. This narrative review provides a comprehensive overview of traditional medical treatments, molecularly targeted therapy and investigational agents in the management of HER2+ breast cancer with BM, highlighting the evolving landscape and potential future directions in treatment strategies to improve patient survival and quality of life.