Skip to main content

Table 1 Treatment Timeline

From: Intrathecal trastuzumab: immunotherapy improves the prognosis of leptomeningeal metastases in HER-2+ breast cancer patient

Date

Disease Progression

Treatment

Serum CA 27.29 (U/mL)

April-2003

Diagnosed with stage II breast cancer

Surgery and adjuvant chemotherapy (adriamysin/cytoxan, and weekly docataxel)

na

March-2007

Developed liver, lungs, lymph nodes, and skeletal metastases

Chemotherapy (gemcitabine/docetaxel with concurrent IV trastuzumab/zoledronic acid), resulted in clinical remission

na

April-2010

Loss of hearing and left facial with recurrence in left internal auditory canal and LM

Cyberknife therapy for IAC tumors and chemotherapy (lapatinib/capecitabine), resulted in significant improvement in neurological symptoms and imaging

na

October-2010

Ommaya inserted

Experimental IT trastuzumab (5 mg flat dose per week)

12.3

January-2011

New parenchymal, thoracic and lumbar LM metastases with additional 5th cerebral nerve and c1 lesions

Whole brain and spine radiation and increased IT trastuzumab (10 mg per week)

12.6

July-2011

Worsening intramedullary c1 lesions

One month of IT trastuzumab (50–80 mg per week) and maximal dose of cyber knife therapy

32.8

March-2013

Developed weakness in left hip/leg and enhancement in previously stable thoracic and lumbar lesions

Increased total dose of IT trastuzumab (50–80 mg BIW, dose divided twice per week) administered by lumbar puncture and ommaya reservoir injections

40

May-2013

No discernable change in disease progression

Trastuzumab (administered bimonthly for maintenance at 50 % of the weekly dose) and lapatinib (750 mg, BID five days weekly), resulted in decreased enhancement and activity of thoracic and lumbar lesions

59

June-2013

Diagnosed with meningitis

Extended antibiotic treatment for two plus months (vancomycin)

58

July-2013

Hiatus from IT with an increase in CA27.29

T-DM1

37

August-2013

Removed ommaya

 

50

September-2013

New ommaya inserted

Restarted IT trastuzumab (40 mg per week)

50

October-2013

Worsening neurological symptoms

IT trastuzumab 50 mg (100 mg per week)

40

August-2014

Patient expired

 

40

  1. Na not available (patient at different clinic)