J Breast Cancer.  2013 Mar;16(1):122-126.

Prolonged Regression of Metastatic Leptomeningeal Breast Cancer That Has Failed Conventional Therapy: A Case Report and Review of the Literature

• Vincent A
• Lesser G
• Brown D
• Vern-Gross T
• Metheny-Barlow L
• Lawrence J
• Chan M

Abstract

Approximately 5% of breast cancer patients develop leptomeningeal metastases over the course of their disease. Though several treatments options are available for these patients, their prognosis is typically considered to be poor. We report a case of leptomeningeal failure after a patient underwent prior radiotherapy, radiosurgery, surgery, chemotherapy, and biologic therapy. This patient experienced a prolonged response after receiving bevacizumab and capecitabine. The literature currently contains several reports regarding the use of systemic therapy to manage leptomeningeal metastases from breast cancer, which we summarize. Finally, we review the relevant effects of the patient's treatment modalities and provide a rationale for the mechanism that led to her prolonged response.

Keyword

Bevacizumab; Breast neoplasms; Capecitabine; Meningeal neoplasms

MeSH Terms

Antibodies, Monoclonal, Humanized
Biological Therapy
Breast
Breast Neoplasms
Deoxycytidine
Fluorouracil
Humans
Meningeal Neoplasms
Neoplasm Metastasis
Prognosis
Radiosurgery
Bevacizumab
Capecitabine
Antibodies, Monoclonal, Humanized
Deoxycytidine
Fluorouracil

Figure

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  Figure 1 Comparative pre-treatment and post-treatment imaging. Gadolinium enhanced T1 coronal magnetic resonance imaging (MRI) taken 1 month prior to initiation of bevacizumab and capecitabine (A) compared with post-treatment gadolinium enhanced T1 coronal MRI (B) illustrating resolution of leptomeningeal enhancement and right posterior temporal lesion.

• 

  Figure 2 Time line of treatment course. CRB=carboplatin; TAX=paclitaxel; TRZ=trastuzumab; GK=gamma knife radiosurgery; IMRT=intensity modulated radiotherapy; SRG=surgical resection; LAP=lapatinib; CAP=capecitabine; BEV=bevacizumab.

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