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CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0045-1809447
Case Report with Review of Literature

Intrathecal Trastuzumab as a Novel Simplified Therapeutic Strategy for Isolated Metastases in the Leptomeninges in HER2-Positive Breast Cancer: A Case Report and Review of Literature

Authors

  • Lokesh K. Nagendrappa 

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Ananda N. Shankaranarayana

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Beulah E. Koshy

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Suresh Babu

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Rudresha A. H.

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Rajeev L. Krishnappa

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Smitha Saldanha

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

  • Ajinkya D. Pophale

    1   Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India

Funding None.
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Abstract

Leptomeningeal metastases is one of the dreaded complications of metastatic breast cancer, which has a very poor prognosis despite standard treatment, which includes systemic chemotherapy, targeted therapy, and radiation therapy. Intrathecal (IT) therapy has also been used in various studies, which includes IT methotrexate and IT trastuzumab (if the cancer is found to be HER2 + ).

We report our experience with the combined modality treatment of systemic chemotherapy with IT trastuzumab in a 52-year-old female patient diagnosed with left breast carcinoma (ER/PR/HER2 status 4/4/3) who progressed in the first year of adjuvant hormonal therapy and developed isolated leptomeningeal metastases. She initially presented with seizures, headache, and neck stiffness. Leptomeningeal enhancement was observed in the magnetic resonance imaging scan of CNS. Positron emission tomography/computed tomography scan showed no evidence of distant metastasis. After confirming cerebrospinal fluid involvement by cytology, the patient was started on IT trastuzumab along with systemic chemotherapy. This resulted in considerable clinical and neurological improvement.

Keywords

case report - leptomeningeal metastases - HER2+ breast cancers - intrathecal - trastuzumab

Author's Contributions

L.K.N.:


Concept: developed the core concept of the case report and provided the overall vision for the manuscript.


Design: led the design of the case report structure and outlined the approach.


Definition of intellectual content: defined the intellectual content, ensuring that the case and its analysis are presented clearly and accurately.


Manuscript preparation: responsible for the initial draft and organization of the manuscript.


A.N.S.:


Concept: contributed to the conceptualization of the case and provided critical insights.


Clinical studies: played a major role in the clinical study aspect, gathering and reviewing the clinical data.


Data acquisition: responsible for collecting the necessary data from clinical records and patient history.


Manuscript preparation: assisted in drafting sections of the manuscript related to clinical findings and interpretation.


B.E.K.:


Design: contributed to the overall structure and design of the manuscript, focusing on the integration of clinical and experimental data.


Data analysis: led the analysis of data presented in the case report, ensuring accuracy and clarity in interpretation.


Statistical analysis: conducted statistical analysis to support the findings and conclusions of the case report.


S.B.:


Literature search: conducted an extensive literature search to support the case report with relevant references and current research.


Manuscript review: assisted in reviewing and proofreading the manuscript for clarity, accuracy, and completeness.


R.A.H.:


Experimental studies: contributed to the experimental data or tests performed as part of the case study.


Data acquisition: helped in the collection of experimental data and clinical observations related to the case.


R.L.K.:


Manuscript editing: participated in editing the manuscript for language, style, and coherence.


Manuscript review: reviewed the manuscript for scientific accuracy and intellectual rigor, ensuring the conclusions are supported by the data.


S.S.:


Clinical studies: contributed to the review of clinical data and assisted in the formulation of the case description.


Manuscript review: played a significant role in reviewing the manuscript and ensuring it adheres to clinical standards.


A.D.P.:


Data acquisition: assisted in gathering data and patient records to support the case report.


Manuscript editing: participated in editing sections of the manuscript to enhance its quality and readability.


Patient's Consent

A written and informed consent was taken from the patient and their kin regarding the publishing of their case summary for educational purposes only. It has also been explained that their patient details are kept anonymous, and identification will be kept confidential.




Publication History

Article published online:
11 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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