Intrathecal trastuzumab in the management of HER2+breast leptomeningeal disease: a single institution experience
Intrathecal trastuzumab in the management of HER2+breast leptomeningeal disease: a single institution experience
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DOI：
10.1007/s10549-018-4684-3
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发表时间：
2018-06-01
影响因子：
3.8
通讯作者：
Ahmed, Kamran A.
中科院分区：
文献类型：
--
作者：
Figura, Nicholas B.;Long, Wendy;Ahmed, Kamran A.
目的：软脑膜疾病是一种罕见的晚期转移性乳腺癌的破坏性表现，历史上总生存率很低。我们评估了鞘内（IT）曲妥珠单抗在HER 2 + lepteningeal diseases.Methods的安全性和可行性，共有13例患者在我们的机构与IT曲妥珠单抗治疗开始2012年11月，并随访至2017年11月。结果，包括颅脊髓进展以及总生存期（OS）开始IT曲妥珠单抗进行了评估，从审查的临床图表和放射学examines.Results患者的中位年龄为48（范围29-75）。从乳腺癌诊断到发生脑转移的中位时间为87.7个月，从脑转移诊断到发生软脑膜疾病的中位时间为4.6个月。大多数患者（92%）既往接受过全脑放疗，23%的患者既往接受过脑转移手术。IT曲妥珠单抗治疗的中位持续时间为6.4个月。从IT曲妥珠单抗治疗开始至颅脊髓进展的中位时间为5.7个月，6个月和12个月Kaplan-Meier率分别为41%和21%。4例患者获得了> 6个月的持续缓解。从IT曲妥珠单抗开始的中位生存期为10.6个月，6个月和12个月OS率分别为68%和47%。IT曲妥珠单抗耐受性良好，一名患者发生脑室炎，这解决了IV antibiotics.Conclusions IT曲妥珠单抗耐受性良好，OS延长超过历史对照。应考虑IT曲妥珠单抗用于HER 2+软脑膜疾病患者的管理。
Purpose Leptomeningeal disease is a rare and devastating presentation of advanced stage metastatic breast cancer with historically poor overall survival. We assessed the safety and feasibility of intrathecal (IT) trastuzumab in HER2+ leptomeningeal disease.Methods A total of 13 patients were treated at our institution with IT trastuzumab beginning November 2012 and followed until November 2017. Outcomes including craniospinal progression as well as overall survival (OS) following initiation of IT trastuzumab were assessed from review of the clinical chart and radiologic examinations.Results The median age of patients was 48 (range 29-75). Median time from breast cancer diagnosis to development of brain metastases was 87.7 months with a median of 4.6 months from brain metastases diagnosis to the development of leptomeningeal disease. Previous whole brain radiotherapy was received by the majority of patients (92%) and prior surgery for brain metastases was performed in 23%. Median duration of IT trastuzumab treatment was 6.4 months. Median time from IT trastuzumab start to craniospinal progression was 5.7 months with 6- and 12-month Kaplan-Meier rates of 41 and 21%, respectively. Sustained responses > 6 months were achieved in 4 patients. Median survival from the start of IT trastuzumab was 10.6 months with 6- and 12-month OS rates of 68 and 47%, respectively. IT trastuzumab was well tolerated with one patient developing ventriculitis, which resolved with IV antibiotics.Conclusions IT trastuzumab was well tolerated with prolongation of OS over historical controls. IT trastuzumab should be considered for management of HER2+ leptomeningeal disease patients.