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Le Rhun E, Taillibert S, Boulanger T, et al. Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases. Case Rep Oncol. 2015;8(1):72-7doi: 10.1159/000375293.
Le Rhun, E., Taillibert, S., Boulanger, T., Zairi, F., Bonneterre, J., & Chamberlain, M. C. (2015). Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases. Case reports in oncology, 8(1), 72-7. https://doi.org/10.1159/000375293
Le Rhun, Emilie, et al. "Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases." Case reports in oncology vol. 8,1 (2015): 72-7. doi: https://doi.org/10.1159/000375293
Le Rhun E, Taillibert S, Boulanger T, Zairi F, Bonneterre J, Chamberlain MC. Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases. Case Rep Oncol. 2015 Feb 12;8(1):72-7. doi: 10.1159/000375293. eCollection 2015. PMID: 25848355; PMCID: PMC4361905.
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Case Rep Oncol. 2015 Feb 12;8(1):72-7. doi: 10.1159/000375293. eCollection 2015.

Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases.

Case reports in oncology

Emilie Le Rhun, Sophie Taillibert, Thomas Boulanger, Fahed Zairi, Jacques Bonneterre, Marc C Chamberlain

Affiliations

  1. Breast Cancer Department, University Hospital - CHRU, Paris, France ; Neuro-Oncology, Department of Neurosurgery, University Hospital - CHRU, Paris, France ; Inserm U-1192, Proteomic, Inflammatory Response, Mass Spectrometry Laboratory (PRISM), Lille 1 University, Villeneuve D'Ascq, Paris, France.
  2. Department of Neurology Mazarin, Pitié-Salpétrière Hospital, Paris, France ; Department of Radiation Oncology, Pitié-Salpétrière Hospital, Paris, France.
  3. Department of Radiology, Oscar Lambret Center, University Hospital - CHRU, Paris, France.
  4. Department of Neurosurgery, Roger Salengro Hospital, University Hospital - CHRU, Paris, France.
  5. Breast Cancer Department, University Hospital - CHRU, Paris, France ; Lille 2 North of France University, Lille, Paris, France.
  6. Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Wash., USA.

PMID: 25848355 PMCID: PMC4361905 DOI: 10.1159/000375293

Abstract

BACKGROUND: Survival of patients with leptomeningeal metastases (LM) and impaired functional status is limited to several months, and rarely does neurological function improve with treatment.

CASE REPORT: A 34-year-old female with hormone-negative and HER2-positive metastatic breast cancer was diagnosed with bulky radiographic LM 45 months after initial diagnosis. She was treated with intra-CSF trastuzumab followed by intra-CSF liposomal cytarabine; however, the cancer progressed 8 months after the diagnosis of LM. At the time of the third LM progression, the patient presented with a cauda equina syndrome and cerebellar impairment resulting in an inability to walk. She was treated with CNS-directed radiotherapy (lumbosacral and cerebellar) and bevacizumab plus vinorelbine. Rapid functional improvement occurred, and the patient regained the ability to walk and independently manage her daily activities. Twelve months later, she presented with rapid progression of the LM resulting in death within several weeks.

CONCLUSION: In radiographically defined bulky LM, the combination of systemic therapy and CNS-directed radiotherapy likely is more active than intra-CSF therapy only. In lieu of the rapid and significant improvement in neurological function combined with the prolonged response, bevacizumab alone or in combination with chemotherapy and CNS-directed radiotherapy may be considered in select patients with radiographically bulky breast cancer-related LM.

Keywords: Bevacizumab; Breast cancer; Leptomeningeal metastases; Neoplastic meningitis; Quality of life; Symptom control

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