Brain metastases affect 25%-30% of women with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer and are associated with a high burden of disease and poor prognosis. A 55-year-old woman presented with HER2-positive, hormone receptor-positive, locally advanced infiltrating ductal carcinoma. She received 4 cycles of neoadjuvant docetaxel (75 mg/m2) plus trastuzumab (6 mg/kg) on a 21-day cycle, resulting in complete pathologic response at the time of surgery. Trastuzumab (6 mg/kg every 21 days) plus anastrozole (1 mg/d) was continued for 1 year. Two years later, the patient progressed with pulmonary nodules and a large pleural effusion. Computed tomography and positron emission tomography revealed multiple lesions in the liver and thoracic spine but no evidence of brain metastases. The patient received weekly trastuzumab (2 mg/kg), paclitaxel (80 mg/m2), and carboplatin (area under the curve 2) for 6 months; her symptoms resolved and her disease stabilized. Seven months later, she developed diplopia and gait difficulties, and magnetic resonance imaging revealed multiple brain lesions. Whole-brain radiotherapy (30 Gy in 10 fractions) was delivered with excellent clinical results. The patient remained progression free without symptoms for approximately 3 months. When she developed central nervous system symptoms, she was treated with lapatinib (1250 mg/d continuously) plus capecitabine (2000 mg/m2 given on days 1-14 of a 21-day cycle). Four months later, a brain computed tomography performed shortly before her death from progressive systemic disease revealed near complete resolution of brain metastases. Lapatinib plus capecitabine seems to have clinical activity in HER2-positive brain metastases.
Division of Hematology/Oncology, Braman Family Breast Cancer Institute, UM Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL.
Supported by grants from GlaxoSmithKline.
Dr. Glück is on the speakers' bureaus, has received clinical research support, and acts as advisor for Abraxis, Eli Lilly, Genomic Health, Genentech, GlaxoSmithKline, Novartis, Pfizer, Roche, and Sanofi-Aventis. Dr. Castrellon has no conflicts of interest.
*Address for correspondence: Division of Hematology/Oncology, Braman Family Breast Cancer Institute, UM Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, 1475 NW 12th Avenue, Suite 3510, Miami, FL 33136. E-mail: firstname.lastname@example.org