Intrathecal administration of trastuzumab for the treatment of meningeal carcinomatosis in her2-positive metastatic breast cancer

• Autores: Carmen García Muñoz, Susana Cortijo Cascajares, Juan Manuel Sepúlveda Sánchez, José Miguel Ferrari Piquero
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 17, Nº. 4, 2015, págs. 9-9
• Idioma: inglés
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• Resumen

  • Objective: Leptomeningeal carcinomatosis (LMC) is an uncommon, but devastating manifestation of metastatic breast cancer. It affects around 5% of patients. Treatment consists of intrathecal (IT) chemotherapy or radiotherapy (RT). The objective of this article is to describe the outcomes of a treatment with IT trastuzumab in two patients diagnosed by HER2+ breast cancer and LMC.

    Patient 1: 64-year-old woman diagnosed by intraductal breast cancer (IBC) in 2003. She received neoadjuvant chemotherapy, RT and anastrozole. In 2012 she was removed incompletely a cerebellar tumour (HER2+). She was treated with capecitabine and lapatinib and cranial RT. In 2013 she was diagnosed of a subarachnoid infiltration in the lumbar area. She was proposed to be treated with IT trastuzumab and methotrexate.

    Patient 2: 45-year-old woman diagnosed by IBC (HER2+) in 2011. She was treated with neoadjuvant chemotherapy and followed by mastectomy in 2012. In 2013, due to leptomeningeal lesions, she started treatment with capecitabine and lapatinib. In July 2013 she received the first cycle of IT trastuzumab and cranial RT.

    Results: Both patients have received 20 and 33 cycles of trastuzumab respectively, getting an important neurological improvement. Side effects included epilepsy, fever and cramps. Time until CNS progression was seven months, similar to observed in another studies.

    Conclusion: Despite the few published studies, IT trastuzumab could be a safe and effective treatment in HER2+ breast cancer patients with LMC