Response of Brain and Meningeal Metastases to Trastuzumab-Deruxtecan in a Patient with HER2-Low Breast Cancer: A Case Report

Abstract Nervous system metastases (CNSm) are late events associated with poor outcomes in endocrine-sensitive HER2-negative breast cancer (BC) patients, especially in the presence of leptomeningeal disease (LMD). Effective treatments are extremely limited in this setting. The antibody-drug conjugat...

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Bibliographic Details
Published in:Case reports in oncology 2023-01, Vol.16 (1), p.1425-1435
Main Authors: Wolf, Benita, Dunet, Vincent, Dubruc, Estelle, Dolcan, Ana, Nicod Lalonde, Marie, Schiappacasse, Luis, Zaman, Khalil
Format: Article
Language:English
Subjects:
Brain cancer
brain metastases
Breast cancer
Case Report
Case reports
Chemotherapy
Cyclin-dependent kinases
Epidermal growth factor
Estrogens
her2-low
Hybridization
Kinases
leptomeningeal disease
Liver
Magnetic resonance imaging
Mastectomy
Medical prognosis
Metastasis
Monoclonal antibodies
Neutropenia
Ovaries
Patients
Radiation
Targeted cancer therapy
trastuzumab-deruxtecan
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Summary:Abstract Nervous system metastases (CNSm) are late events associated with poor outcomes in endocrine-sensitive HER2-negative breast cancer (BC) patients, especially in the presence of leptomeningeal disease (LMD). Effective treatments are extremely limited in this setting. The antibody-drug conjugate, trastuzumab-deruxtecan (T-DXd), which combines the anti-HER2 antibody trastuzumab with a topoisomerase type 1 inhibitor, showed high efficacy not only against HER2-positive but also HER2-low metastatic BCs, expressing HER2 at a lower level. To the best of our knowledge, this is the first report of a patient with metastatic endocrine-sensitive HER2-low BC suffering from BMs associated with LMD and sustained disease control when treated with T-DXd. Several recent case series have reported the activity of T-DXd in patients with HER2-positive disease and brain metastases or LMD, but none in HER2-low patients. This case is particularly relevant since more than 50% of BCs are HER2-low.
ISSN:1662-6575
1662-6575
DOI:10.1159/000534572