内容紹介
A Case of Effective Whole-Brain Irradiation and Lapatinib/Capecitabine Combination Therapy for HER2-Positive Breast Cancer with Multiple Brain Metastases
Summary
We report the case of a 48-year-old female patient with HER2-positive and hormone receptor-negative breast cancer with multiple liver metastases. She underwent 6 cycles of FEC followed by docetaxel plus trastuzumab(TZB), resulting in a clinical complete response. After 15 cycles of a TZB-containing regimen, she complained of dizziness and nausea, and imaging examinations revealed multiple brain metastases. Whole-brain irradiation(33.6 Gy)was performed, and the chemotherapy regimen was changed to lapatinib(LAP: orally at 1,250 mg/day, every day)and capecitabine(CAP: orally at 2,000 mg/m2, every day for 2 weeks, followed by a 1-week rest interval, as 1 cycle). After 6 weeks of the new treatment, magnetic resonance imaging revealed marked shrinkage of brain metastases. A clinical complete response was maintained for 19 months. While brain metastasis is an important problem with treatment with TZB, LAP is drawing attention because of its ability to pass the blood-brain barrier because of its small molecular weight. LAP/CAP combination therapy may be an effective treatment option for brain metastases of HER2-positive breast cancer in which TZB essentially has no effect.
要旨
症例は48歳,女性。多発肝転移を伴ったHER2陽性・ホルモン感受性陰性の乳癌患者である。FEC 6サイクル施行後,docetaxel+trastuzumab(TZB)の併用療法を行い,肝転移はCRの状態が維持されていた。15サイクル施行後にめまいと嘔気が出現し,精査にて多発脳転移を認めた。全脳照射(33.6 Gy)とともに,lapatinib(LAP 1,250 mg/day,連日経口投与)・capecitabine(CAP 2,000 mg/m2/day,2週連日経口投与1週休薬を1サイクル)併用療法に変更した。6週後のMRIにて,脳転移の著明な縮小が確認された。以後,1年7か月後の現在まで臨床的完全寛解が得られている。TZB治療中の脳転移が問題とされるなかで,LAPは分子量が小さく血液脳関門(blood-brain barrier)を通過することが知られており,LAP・CAP併用療法はTZBの効果が及ばない乳癌脳転移に対して有力な治療法になり得ると考えられた。
目次
Summary
We report the case of a 48-year-old female patient with HER2-positive and hormone receptor-negative breast cancer with multiple liver metastases. She underwent 6 cycles of FEC followed by docetaxel plus trastuzumab(TZB), resulting in a clinical complete response. After 15 cycles of a TZB-containing regimen, she complained of dizziness and nausea, and imaging examinations revealed multiple brain metastases. Whole-brain irradiation(33.6 Gy)was performed, and the chemotherapy regimen was changed to lapatinib(LAP: orally at 1,250 mg/day, every day)and capecitabine(CAP: orally at 2,000 mg/m2, every day for 2 weeks, followed by a 1-week rest interval, as 1 cycle). After 6 weeks of the new treatment, magnetic resonance imaging revealed marked shrinkage of brain metastases. A clinical complete response was maintained for 19 months. While brain metastasis is an important problem with treatment with TZB, LAP is drawing attention because of its ability to pass the blood-brain barrier because of its small molecular weight. LAP/CAP combination therapy may be an effective treatment option for brain metastases of HER2-positive breast cancer in which TZB essentially has no effect.
要旨
症例は48歳,女性。多発肝転移を伴ったHER2陽性・ホルモン感受性陰性の乳癌患者である。FEC 6サイクル施行後,docetaxel+trastuzumab(TZB)の併用療法を行い,肝転移はCRの状態が維持されていた。15サイクル施行後にめまいと嘔気が出現し,精査にて多発脳転移を認めた。全脳照射(33.6 Gy)とともに,lapatinib(LAP 1,250 mg/day,連日経口投与)・capecitabine(CAP 2,000 mg/m2/day,2週連日経口投与1週休薬を1サイクル)併用療法に変更した。6週後のMRIにて,脳転移の著明な縮小が確認された。以後,1年7か月後の現在まで臨床的完全寛解が得られている。TZB治療中の脳転移が問題とされるなかで,LAPは分子量が小さく血液脳関門(blood-brain barrier)を通過することが知られており,LAP・CAP併用療法はTZBの効果が及ばない乳癌脳転移に対して有力な治療法になり得ると考えられた。