Abstract YO3
Case summary
Her2neu-positive breast cancers have higher incidences of brain metastasis. Tucantinib and T-Dxd have shown better intracranial responses as compared to other anti-Her2neu therapy.
Our case is a 63 year old female was diagnosed with stage 4 Her2neu positive breast cancer in Oct 2019. She initially received chemotherapy + trastuzumab + pertuzumab for which she had duration of response for 16 months. She later developed brain metastasis for which stereotactic radiotherapy was given followed by multiple lines of anti Her2 agents: TDM1, Lapatinib+capecitabine with duration of response (DOR) of 15 and 9 months respectively. She subsequently presented with complaints of headache and weakness again. Her MRI brain showed increase in size of cerebellar metastasis, new metastasis in left temporal lobe, meningeal dissemination and acute hydrocephalus due to fourth ventricular compression. She underwent VP shunt placement and she was initiated on treatment with TDX-d. Her MRI brain done after 3 cycles showed dramatic response with reduction in the cerebellar lesion and reduction in perilesional edema with significant clinical improvement. She is neurologically stable with an ongoing response of 17 months.
This case demonstrated remarkable response to TDX-d in case of active brain metastasis creating a new ray of hope in this space.