Stemmler Hans-Joachim, Mengele Karin, Schmitt Manfred, Harbeck Nadia, Laessig Dorit, Herrmann Karin A, Schaffer Pamela, Heinemann Volker
Medical Department III, Ludwig-Maximilians-University of Munich, Klinikum Grosshadern, Munich, Germany.
Anticancer Drugs. 2008 Sep;19(8):832-6. doi: 10.1097/CAD.0b013e32830b58b0.
Leptomeningeal carcinomatosis represents a rare manifestation of metastatic breast cancer (MBC). We herewith report on a patient suffering from HER2 overexpressing MBC who received intrathecal methotrexate and trastuzumab for meningeal carcinomatosis. A 48-year-old woman was diagnosed with breast cancer in December 2002. Following surgery, six cycles of adjuvant FE100C plus irradiation and, subsequently for 1 year, trastuzumab were given. As a result of disseminated metastatic spread in October 2005, the patient received whole-brain radiotherapy for symptomatic central nervous system involvement, and was put on several trastuzumab-based combination regimens (capecitabine, vinorelbine, paclitaxel). In June 2006, the patient developed clinical signs of terminal cone involvement with overflow incontinence and paraparesis of the legs. Immediate radiation led to partial relief from clinical symptoms. Subsequently, the patient was put on the tyrosine kinase inhibitor lapatinib and capecitabine (August to October 2007), but on November 6th the patient suffered again from overflow incontinence and weakness of the legs. Failing to respond to lapatinib, the patient received gemcitabine/cisplatin and, additionally, was recommenced on intravenous trastuzumab. Owing to progressive leptomeningeal disease, the patient received repeated doses of intrathecal methotrexate and trastuzumab. Within 2 weeks and four intrathecal treatments, cerebrospinal fluid cytology showed the absence of tumor cells. Moreover, a striking clinical improvement with resolution of the paraparesis of the legs and overflow incontinence was observed. This case report gives details regarding the clinical course of a breast cancer patient who received intrathecal trastuzumab and methotrexate via lumbar puncture for meningeal carcinomatosis of HER2-overexpressing MBC.
柔脑膜癌病是转移性乳腺癌（MBC）的一种罕见表现。我们在此报告一例HER2过表达的MBC患者，其因脑膜癌病接受了鞘内注射甲氨蝶呤和曲妥珠单抗治疗。一名48岁女性于2002年12月被诊断为乳腺癌。手术后，给予六个周期的辅助化疗方案FE100C加放疗，随后给予曲妥珠单抗治疗1年。由于2005年10月出现广泛转移，患者因有症状的中枢神经系统受累接受了全脑放疗，并接受了几种基于曲妥珠单抗的联合治疗方案（卡培他滨、长春瑞滨、紫杉醇）。2006年6月，患者出现终丝受累的临床症状，表现为充溢性尿失禁和双下肢轻瘫。立即放疗使临床症状部分缓解。随后，患者接受了酪氨酸激酶抑制剂拉帕替尼和卡培他滨治疗（2007年8月至10月），但在11月6日，患者再次出现充溢性尿失禁和双下肢无力。因对拉帕替尼无反应，患者接受了吉西他滨/顺铂治疗，此外，再次开始静脉注射曲妥珠单抗。由于柔脑膜疾病进展，患者接受了多次鞘内注射甲氨蝶呤和曲妥珠单抗治疗。在2周内进行了4次鞘内治疗后，脑脊液细胞学检查显示无肿瘤细胞。此外，观察到双下肢轻瘫和充溢性尿失禁症状明显改善并消失。本病例报告详细介绍了一名乳腺癌患者的临床病程，该患者因HER2过表达的MBC脑膜癌病通过腰椎穿刺接受了鞘内注射曲妥珠单抗和甲氨蝶呤治疗。
