BM-18 * PROLONGED RESPONSE WITH BEVACIZUMAB + NAVELBINE AS THIRD LINE OF TREATMENT OF BREAST CANCER LEPTOMENINGEAL METASTASES: A CASE REPORT

Abstract

Approximately 5% of breast cancer (BC) will develop leptomeningeal metastases (LM) during the course of the disease. The median overall survival remains limited to several months despite aggressive treatment. We report the case of a patient with a prolonged response to bevacizumab (BEV) and vinorelbine as third line of treatment of LM. A 29-year-old patient was diagnosed in 2008 with an invasive ductal carcinoma with negative hormonal receptors and overexpressed HER2. She initially received neoadjuvant chemotherapy plus trastuzumab, surgery and radiotherapy. She presented in December 2011 with hepatic, bones and lung metastases and received docetaxel plus trastuzumab during 6 months then trastuzumab alone. Nodular LM were diagnosed in September 2012 and the patient was enrolled in a trial and received intra-CSF and intra-venous (iv.) trastuzumab plus capecitabine. A first isolated progression of LM was diagnosed in February 2013, and was treated with a combination of intraventricular liposomal cytarabine, lapatinib, iv. trastuzumab and capecitabine. A second isolated LM progression was observed in May 2013. At that time, the patient presented with a cauda equina syndrom and cerebellar impairment leading to the need of a wheeling chair and assistance in her daily life. She received sites-specific radiotherapy (cauda equina + posterior fossa) and a BEV + vinorelbine association was initiated. Treatment was well tolerated. A rapid functional improvement occurred and the patient was able to walk again and to handle her daily activities. In April 2014, she presented with rapidly progressive headaches and vomiting. Only one cycle of trastuzumab and paclitaxel could be given as the medical condition impaired very quickly. Due to the important improvement of the general condition of our patient with initially bulky LM of the posterior fossa and due to the prolonged response observed, BEV in combination with chemotherapy should be considered for these patients.