Long-term Survival after Cerebellar Metastasis Resection from Her2 3+ Locally Advanced Breast Cancer

Abstract

We present a patient who first developed a distant metastatic site in the cerebellum during treatment for Her2 3+ locally advanced breast cancer (LABC). LABC was in complete remission at that time and isolated cerebellar metastasis was resected. The patient is still alive more than 135 months after LABC diagnosis, and more than 99 months after neurosurgery, and is still receiving trastuzumab without further progression or any toxicity. To the best of our knowledge, this is first report of such exceptional disease course for a patient with a predicted grave prognosis according to all prognostic parameters. KeywordsBreast cancer brain metastases, cerebellar metastases, locally advanced Her2 3+ breast cancer, long-term survival Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in the study.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Breast cancer brain metastases (BCBM) represent a devastating event with limited survival upon diagnosis of approximately 6 months. Incidence of symptomatic BCBM ranges from 10 to 46 % during metastatic BC course and in 3-6 % of patients who are treated for early BC. 1-7 Although BM cannot be predicted, risk varies according to BC molecular subtype and is highest for triple negative and Her2+ BC. 2,5,[8][9][10] However, there are reports suggesting more favourable prognosis for patients with Her2 3+ BM than for patients with other BC subtypes, but only if trastuzumab is continued beyond BM diagnosis and if there is no progression in other metastatic sites. [11][12][13] In a large study with 598 patients with BCBM, survival of patients who continued with trastuzumab after BM diagnosis was a median 11.6 months compared with a median 6.1 months if trastuzumab was not continued and a median 6.3 months for patients with Her2-BC. Received 11Whether that favourable outcome can also be applied for Her2 3+ cerebellar metastases has not be widely explored because of their rarity.According to our previous research, Her2 3+ BC seemingly has a special predilection to the cerebellum compared with other BC molecular types. 14 Here, we present a patient with Her2 3+ locally advanced breast cancer (LABC) and first distant metastatic site in cerebellum. LABC was in complete remission at that time and isolated cerebellar metastasis was resected. The patient is alive for more than 135 months after LABC diagnosis, and more than 99 months after neurosurgery, and continues to receive trastuzumab without further progression or any toxicity. Case ReportIn January 2004, a 43-year-old pre-menopausal patient noticed a lump in the left breast. Mammography confirmed 6 x 7 cm tumour at the outer...