多学科精准治疗乳腺癌脑转移一例
Multidisciplinary precision treatment of brain metastasis in breast cancer: a case report
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摘要: 人类表皮生长因子受体2(HER2)阳性乳腺癌的侵袭性强、复发率高且预后不良。约50%的转移性HER2阳性乳腺癌患者会出现脑转移。靶向治疗延长了乳腺癌患者的生存期,但是如何突破血脑屏障以提高乳腺癌脑转移的预后效果,仍然是研究者面临的一大难题。该文报道了1例对曲妥珠单抗和小分子酪氨酸激酶抑制剂 (TKI)耐药且曲妥珠单抗-美坦新偶联物(TDM-1)药物不可及的HER2阳性乳腺癌脑转移患者,经综合乳腺外科、肿瘤内科、病理科、影像科等多学科意见后接受伊尼妥单抗治疗,其在治疗过程中颅外病变稳定、颅内病变进展,在保留系统性治疗方案不变、加强局部治疗干预的情况下,其病情得到了较好的控制。该例的诊治过程提示,对于HER2阳性乳腺癌脑转移患者的治疗方式选择,应该综合考虑患者脑转移灶及颅外病灶的特征、其身体和经济状况以及既往接受过的治疗方式,多学科诊疗有助明确其最佳个体化治疗方案,改善患者预后。Abstract: Human epidermal growth factor receptor-2 (HER2) -positive breast cancer is highly aggressive, with high recurrence rate and poor prognosis. Approximately 50% of patients with metastatic HER2-positive breast cancer will develop brain metastases. In recent years, the emergence of targeted therapy has significantly prolonged the survival of breast cancer patients. However, how to penetrate the blood-brain barrier and improve prognostic effect of breast cancer brain metastasis is still a challenge facing researchers. Here, we reported a case of HER2-positive breast cancer patient with brain metastasis who was resistant to trastuzumab and small-molecule tyrosine kinase inhibitor (TKI) and could not be reached by trastuzumab emtansine (TDM-1). After multidisciplinary consultation by Department of Breast Surgery, Department of Oncology, Department of Pathology and Department of Imaging, the patient was treated with inetetamab. Throughout the treatment, the patient had stable extracranial lesions and progressive intracranial lesions. Hence, systemic treatment was continued and local treatment intervention was strengthened. The progression of disease was effectively controlled. The diagnosis and treatment of this case suggest that treatment methods for patients with HER2-positive breast cancer with brain metastases should be determined according to the characteristics of brain metastases and extracranial lesions, physical and economic status and previous treatment mode. Multidisciplinary diagnosis and treatment contribute to identifying the optimal individualized treatment and improving clinical prognosis.
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