背景:乳腺癌脑转移(BCBM)是一种晚期乳腺疾病,难以治疗,并且与高死亡风险相关。患者预后通常较差,降低生活质量。在这种情况下,我们报道了1例HER-2阳性BCBM患者接受大分子mAb(inetetamab)联合小分子酪氨酸激酶抑制剂(TKI)治疗.
方法:患者为一名58岁女性,有12年2型糖尿病病史。她符合常规胰岛素治疗,血糖控制良好。患者被诊断为右乳腺浸润性癌(T3N1M0IIIa期,HER2阳性类型)由于2019年2月发现乳腺肿瘤,通过同侧乳腺的抽吸活检。免疫组织化学显示ER(-),PR(-),HER-2(3+),和Ki-67(55-60%+)。术前新辅助化疗,即,AC-TH方案(表柔比星,环磷酰胺,多西他赛-紫杉醇,和曲妥珠单抗),给药8个周期。她于2019年11月接受了右乳改良根治术,并接受了托珠单抗靶向治疗1年。术后9mo发现脑转移。她于2020年8月接受了脑转移瘤切除术。免疫组织化学显示ER(-)和PR。(-),HER-2(3+),和Ki-67(10-20%+)。2020年11月,患者出现头痛症状。经过检查,观察到原始手术区域的肿瘤复发,病人接受了inetamab治疗,pyrotinib,和卡培他滨.建议全脑放疗。患者及其家人因个人原因拒绝放疗。2021年9月,例行检查显示脑瘤要大得多。继续原来的全身治疗,并结合调强放疗治疗脑转移,其次是定期住院和常规检查。患者病情总体稳定,她的生活质量相对较高。本病例报告表明,在BCBM和曲妥珠单抗耐药的患者中,伊奈他单抗联合吡罗替尼和化疗可以延长生存期。
结论:Inetetamab联合小分子TKI药物,化疗和放疗可能是维持BCBM患者病情稳定的有效方案.
BACKGROUND: Breast cancer brain metastasis (BCBM) is an advanced breast disease that is difficult to treat and is associated with a high risk of death. Patient prognosis is usually poor, with reduced quality of life. In this context, we report the
case of a patient with HER-2-positive BCBM treated with a macromolecular mAb (inetetamab) combined with a small molecule tyrosine kinase inhibitor (TKI).
METHODS: The patient was a 58-year-old woman with a 12-year history of type 2 diabetes. She was compliant with regular insulin treatment and had good blood glucose control. The patient was diagnosed with invasive carcinoma of the right breast (T3N1M0 stage IIIa, HER2-positive type) through aspiration biopsy of the ipsilateral breast due to the discovery of a breast tumor in February 2019. Immunohistochemistry showed ER (-), PR (-), HER-2 (3+), and Ki-67 (55-60%+). Preoperative neoadjuvant chemotherapy, i.e., the AC-TH regimen (epirubicin, cyclophosphamide, docetaxel-paclitaxel, and trastuzumab), was administered for 8 cycles. She underwent modified radical mastectomy of the right breast in November 2019 and received tocilizumab targeted therapy for 1 year. Brain metastasis was found 9 mo after surgery. She underwent brain metastasectomy in August 2020. Immunohistochemistry showed ER (-) and PR. (-), HER-2 (3+), and Ki-67 (10-20%+). In November 2020, the patient experienced headache symptoms. After an examination, tumor recurrence in the original surgical region of the brain was observed, and the patient was treated with inetetamab, pyrotinib, and capecitabine. Whole-brain radiotherapy was recommended. The patient and her family refused radiotherapy for personal reasons. In September 2021, a routine examination revealed that the brain tumor was considerably larger. The original systemic treatment was continued and combined with intensity-modulated radiation therapy for brain metastases, followed by regular hospitalization and routine examinations. The patient\'s condition is generally stable, and she has a relatively high quality of life. This
case report demonstrates that in patients with BCBM and resistance to trastuzumab, inetetamab combined with pyrotinib and chemotherapy can prolong survival.
CONCLUSIONS: Inetetamab combined with small molecule TKI drugs, chemotherapy and radiation may be an effective regimen for maintaining stable disease in patients with BCBM.