HER2-positive recurrent breast cancer and metastases of breast cancer, including life-threatening metastases to the brain and dura mater: a case effectively treated with lapatinib plus capecitabine before whole brain radiotherapy

Abstract

Lapatinib is a new small molecule tyrosine kinase inhibitor. It targets both ErbB1 and ErbB2 (HER2) receptors and directly and reversibly acts on them to inhibit signaling. Since lapatinib has a low molecular weight, it can cross the blood–brain barrier. Thus, there is much interest in its potential effectiveness against brain metastases. Our patient was a 57-year-old postmenopausal woman with a non-contributory medical history. In September 2006, she underwent a partial mastectomy and axillary dissection for right breast cancer. Pathological diagnosis was solid-tubular carcinoma, n+ (6/23), nuclear grade 3, ly1, v0, ER+, PgR−, and HER2 3+ (pT1cN2aM0-stageIIIA). Adjuvant chemotherapy consisted of 6 cycles of epirubicin and cyclophosphamide (EC) and subsequent oral anastrozole. In May 2009, the patient developed choroidal, lung, liver, bone, and lymph node metastases. She underwent radiation therapy (choroids 40 Gy and cervical vertebrae 40 Gy), and the oral drug was changed to high-dose toremifene. In July 2009, the patient developed headache, vomiting, and seizures. MRI revealed multiple brain metastases and dura mater metastases. Administration of glycerol and steroid was begun. In addition, administration of lapatinib (1,250 mg/body, daily) plus capecitabine (2,000 mg/m2, day 1–14, every 3 weeks) was begun for treatment of brain and systemic metastatic lesions. Neurological symptoms improved on day 14. In January 2010, examinations revealed partial response of all metastatic lesions, including brain metastases. The patients continued the same treatment but exhibited progressive disease in March 2010. Thus, the treatment was discontinued as per the patient’s request. In May 2010, the patient developed generalized seizures again and underwent whole brain radiotherapy (30 Gy). However, the patient’s general condition gradually deteriorated and the patient died in June 2010.