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鞘内注射曲妥珠单抗治疗人表皮生长因子受体2阳性原发灶不明的癌性软脑膜转移：一例报告

Intrathecal Trastuzumab for HER2-Positive Cancer of Unknown Primary Leptomeningeal Metastasis: A Case Report.

作者信息

Oka Kohei, Futamura Shun, Harada Taishi

机构信息

Department of Medical Oncology, Fukuchiyama City Hospital, Fukuchiyama, JPN.

出版信息

Cureus. 2024 Mar 31;16(3):e57322. doi: 10.7759/cureus.57322. eCollection 2024 Mar.

DOI:10.7759/cureus.57322
PMID:38690464
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11060115/
Abstract

Cancer of unknown primary (CUP) and leptomeningeal metastasis are difficult conditions with limited treatment options. We report a case of CUP leptomeningeal metastasis that was refractory to empirical chemotherapy but achieved a favorable response to intrathecal trastuzumab after the identification of human epidermal growth factor receptor-2 (HER2) amplification. A 59-year-old woman was diagnosed with CUP with metastasis of a poorly differentiated carcinoma to the left axillary, anterior mediastinal, peritoneal, and bilateral supraclavicular lymph nodes. Leptomeningeal metastasis was confirmed shortly after she started empiric chemotherapy; empiric therapy with intrathecal methotrexate failed to relieve her symptoms. Meanwhile, the lymph node specimen tested positive for HER2 amplification. She underwent intrathecal trastuzumab, then her neurological symptoms resolved the following day. We suggest that intrathecal trastuzumab is an effective treatment for HER2-positive CUP leptomeningeal metastasis.

摘要

原发灶不明的癌症（CUP）和软脑膜转移是治疗选择有限的疑难病症。我们报告一例CUP软脑膜转移病例，该病例对经验性化疗耐药，但在检测到人类表皮生长因子受体2（HER2）扩增后，鞘内注射曲妥珠单抗取得了良好疗效。一名59岁女性被诊断为CUP，低分化癌转移至左腋窝、前纵隔、腹膜及双侧锁骨上淋巴结。在她开始经验性化疗后不久确诊为软脑膜转移；鞘内注射甲氨蝶呤的经验性治疗未能缓解其症状。同时，淋巴结标本检测HER2扩增呈阳性。她接受了鞘内注射曲妥珠单抗治疗，第二天神经症状即得到缓解。我们认为，鞘内注射曲妥珠单抗是治疗HER2阳性CUP软脑膜转移的有效方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/4681419b427a/cureus-0016-00000057322-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/4f11c749468a/cureus-0016-00000057322-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/7f765d54bc80/cureus-0016-00000057322-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/4681419b427a/cureus-0016-00000057322-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/4f11c749468a/cureus-0016-00000057322-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/7f765d54bc80/cureus-0016-00000057322-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50b3/11060115/4681419b427a/cureus-0016-00000057322-i03.jpg

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本文引用的文献

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Leptomeningeal Metastasis: A Review of the Pathophysiology, Diagnostic Methodology, and Therapeutic Landscape.脑膜转移：病理生理学、诊断方法学和治疗全景的综述。
Curr Oncol. 2023 Jun 19;30(6):5906-5931. doi: 10.3390/curroncol30060442.
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Cancer of unknown primary: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.原发灶不明癌：ESMO 诊断、治疗及随访临床实践指南
Ann Oncol. 2023 Mar;34(3):228-246. doi: 10.1016/j.annonc.2022.11.013. Epub 2022 Dec 20.
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Phase II study of intrathecal administration of trastuzumab in patients with HER2-positive breast cancer with leptomeningeal metastasis.
曲妥珠单抗鞘内注射治疗 HER2 阳性乳腺癌伴脑膜转移的Ⅱ期临床研究。
Neuro Oncol. 2023 Feb 14;25(2):365-374. doi: 10.1093/neuonc/noac180.
4
Treatment of Leptomeningeal Carcinomatosis Following Treatment of Cerebellar Metastasis of HER2+ (Human Epidermal Growth Factor Receptor 2 Positive) Breast Cancer: Case Report and Review of Literature.HER2+（人表皮生长因子受体2阳性）乳腺癌小脑转移治疗后软脑膜癌病的治疗：病例报告及文献复习
Cureus. 2022 Apr 10;14(4):e24008. doi: 10.7759/cureus.24008. eCollection 2022 Apr.
5
Clinical outcomes of breast leptomeningeal disease treated with intrathecal trastuzumab, intrathecal chemotherapy, or whole brain radiation therapy.接受鞘内曲妥珠单抗、鞘内化疗或全脑放疗治疗的乳腺软脑膜疾病的临床结局。
Breast Cancer Res Treat. 2019 Jun;175(3):781-788. doi: 10.1007/s10549-019-05170-7. Epub 2019 Mar 11.
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Intrathecal trastuzumab in the management of HER2+ breast leptomeningeal disease: a single institution experience.鞘内注射曲妥珠单抗治疗 HER2+ 乳腺癌软脑膜疾病：单中心经验。
Breast Cancer Res Treat. 2018 Jun;169(2):391-396. doi: 10.1007/s10549-018-4684-3. Epub 2018 Feb 1.
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Intrathecal trastuzumab: immunotherapy improves the prognosis of leptomeningeal metastases in HER-2+ breast cancer patient.鞘内注射曲妥珠单抗：免疫疗法改善 HER-2+乳腺癌患者的脑膜转移预后。
J Immunother Cancer. 2015 Sep 15;3:41. doi: 10.1186/s40425-015-0084-y. eCollection 2015.
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Intrathecal Trastuzumab Treatment in Patients with Breast Cancer and Leptomeningeal Carcinomatosis.鞘内注射曲妥珠单抗治疗乳腺癌合并脑膜转移患者。
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