Statement: anaplastic brain stem glioma is an anaplastic glioma that arises from the brain stem. all patients accepted into the primary trial have undergone Prior treatment for breast cancer with endocrine therapy.
Primary_evidence: Inclusion Criteria:   Adult Women ( 18 years old).   Histologically or cytologically confirmed invasive breast carcinoma with local recurrence or radiological evidence of metastatic disease.   Must have at least one lesion that can be accurately measured or bone lesions in the absence of measurable disease.   HER2+ patients by local laboratory testing (IHC 3+ staining or in situ hybridization positive).   Prior trastuzumab and/or chemotherapy (taxanes included) as neo-adjuvant or adjuvant treatment is allowed but should be discontinued > 12 months prior to randomization.   Prior treatment for breast cancer with endocrine therapy (adjuvant or metastatic settings) is allowed but should be discontinued at randomization. Patients treated with bisphosphonates at entry or who start bisphosphonates during study may continue this therapy during protocol treatment.   Documentation of negative pregnancy test.   Organ functions at time of inclusion. Exclusion Criteria:   Prior mTOR inhibitors for the treatment of cancer.   Other anticancer therapy for locally advanced or metastatic breast cancer except for prior hormonal therapy.   Patients with only non-measurable lesions other than bone metastasis (e.g. pleural effusion, ascites, etc).   Radiotherapy to  25% of the bone marrow within 4 weeks prior to randomization   History of central nervous system metastasis.   Impairment of gastrointestinal (GI) function or GI disease or active ulceration of the upper gastrointestinal tract.   Serious peripheral neuropathy.   Cardiac disease or dysfunction.   Uncontrolled hypertension. HIV. Pregnant,