Trastuzumab
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Cerebral metastases: case report A 51-year-old woman diagnosed with HER2-positive ductal breast cancer (cT2N1M0) underwent radical mastectomy with axillary lymphadenectomy and received adjuvant chemotherapy associated with trastuzumab for 1 year. Two years after diagnosis she presented to hospital with a generalised epileptic seizure, and reported symptoms of diplopia and upper neck pain that had evolved over 7 days. A cranial CAT scan indicated metastasis so IV valproic acid and dexamethasone were started. A cerebral MRI confirmed two lesions in the right parietal and temporal lobes, and these were resected surgically. Three weeks later the woman reported neck pain, nausea and drowsiness; repeat MRI findings indicated meningeal carcinomatosis and a lumbar puncture revealed cytology positive for malignant cells and indicative of metastasis of carcinoma of mammary origin. Intrathecal methotrexate treatment was started but the woman’s condition deteriorated rapidly and she died a few days later. Author comment: [T]rastuzumab’s efficiency in systemic control of micrometastases and in prolongation of survival has the result that the appearance of symptomatic metastases is delayed, in comparison with patients not treated with trastuzumab, whose survival is less. Ayuga Loro F, et al. Trastuzumab’s association with cerebral metastases and meningeal carcinomatosis in a patient with HER2-positive breast cancer. Medicina Clinica 133: 279-280, No. 7, 18 Jul 2009 [Spanish; summarised from a translation] 801154885 - Spain
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Reactions 9 Jan 2010 No. 1283
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