Goodman Oscar B, Milowsky Matthew I, Kaplan Jodi, Hussain Maha, Nanus David M
J Med Case Rep. 2009 Sep 15;3:9110. doi: 10.4076/1752-1947-3-9110.
Targeted therapies may impact the natural history of bladder cancer based upon their pharmacokinetics. The Her2/neu receptor tyrosine kinase, overexpressed by half of all primary urothelial carcinomas, has recently been examined as a therapeutic target in bladder cancer in a prospective phase II multicenter trial (NCI-198) that enrolled 109 patients with advanced bladder carcinomas for treatment with trastuzumab in combination with paclitaxel, carboplatin, and gemcitabine. We report on documented isolated Her2/neu positive carcinomatous meningitis in a patient treated with trastuzumab.
A 61-year-old Caucasian man with metastatic bladder cancer was treated with neoadjuvant chemotherapy in combination with trastuzumab with a partial response that was followed by a complete response after surgery. He relapsed with isolated Her2/neu positive carcinomatous meningitis.
Carcinomatous meningitis in bladder cancer is extremely rare. This is the first case reported of Her2/neu positive carcinomatous meningitis. Disease recurred solely at a sanctuary site, demonstrating that despite the systemic efficacy of trastuzumab in combination with chemotherapy, its inability to enter the central nervous system potentially contributes to the unusual site of disease recurrence.
基于其药代动力学，靶向治疗可能会影响膀胱癌的自然病程。Her2/neu受体酪氨酸激酶在所有原发性尿路上皮癌中有一半呈过表达，最近在一项前瞻性II期多中心试验（NCI-198）中被作为膀胱癌的治疗靶点进行研究，该试验纳入了109例晚期膀胱癌患者，采用曲妥珠单抗联合紫杉醇、卡铂和吉西他滨进行治疗。我们报告了1例接受曲妥珠单抗治疗的患者发生孤立性Her2/neu阳性癌性脑膜炎的病例。
一名61岁的转移性膀胱癌白人男性接受了新辅助化疗联合曲妥珠单抗治疗，部分缓解，术后完全缓解。他复发时出现孤立性Her2/neu阳性癌性脑膜炎。
膀胱癌中的癌性脑膜炎极为罕见。这是首例报告的Her2/neu阳性癌性脑膜炎病例。疾病仅在一个“避难所”部位复发，表明尽管曲妥珠单抗联合化疗具有全身疗效，但其无法进入中枢神经系统可能导致了疾病复发的不寻常部位。
