Supplementary FCO 2023

Abstract

Abstract Background Prognosis remains poor in patients with leptomeningeal carcinoma. The time from diagnosis to death is about 4–6 weeks if left untreated. With treatment, the overall survival is approximately 2–4 months. Case description A 59-year-old female with a history of left breast carcinoma was admitted to the hospital due to newly diagnosed right breast type I lobular carcinoma, classified as T2N2Mx with a pathological stage IIIA. She underwent mastectomy with axillary clearance. Immunohistochemical staining assays revealed positive results for both estrogen receptor (ER) with a total score of 7/8 and progesterone receptor (PR) with a total score of 6/8. Human epidermal growth factor receptor 2 (HER-2) expression was assessed as negative with a score of +1. Abdominal computed tomography (CT) showed the presence of ascites. Microscopic examination indicated invasive lobular carcinoma, classic type, grade II. Of the 14 axillary lymph nodes examined, seven were found to be involved by metastasis with focal infiltration of axillary fatty tissue. The CA-125 protein test yielded a measurement of 212, and CA 15/3 was recorded as greater than 300. Treatment commenced with six cycles of adjuvant CMF combination therapy, consisting of cyclophosphamide, methotrexate, and 5-fluorouracil. Subsequently, the patient received vinorelbine in combination with zoledronic acid, everolimus, intrathecal methotrexate, and carboplatin paired with gemcitabine. By the end of 2020, bone metastasis was observed on a bone magnetic resonance imaging (MRI), along with thin leptomeningeal infiltration. Conclusion This was a rare case of a female who presented with leptomeningeal metastasis in breast cancer and was found to have a long survival of 18 months after she received intrathecal therapy with systemic therapy.