Cancer Res Treat.  2016 Jan;48(1):403-408. 10.4143/crt.2014.165.

Effective Treatment of Solitary Pituitary Metastasis with Panhypopituitarism in HER2-Positive Breast Cancer by Lapatinib

• Park Y
• Kim H
• Kim EH
• Suh CO
• Lee S

• KMID: 2152300
• DOI: http://doi.org/10.4143/crt.2014.165

Abstract

Brain metastasis affects one third of patients with HER2-positive breast cancer after treatment with trastuzumab. Surgical resection and radiation therapy are often unsuccessful at accomplishing complete control of metastasis. Lapatinib is presumed to cross the blood-brain barrier, and exhibits clinical activities for treatment of HER2-positive breast cancer. A 43-year-old woman was treated for early breast carcinoma with total mastectomy, axillary lymph-node dissection, and adjuvant chemotherapy with cyclophosphamide plus doxorubicin. After the end of adjuvant trastuzumab therapy, she was diagnosed with panhypopituitarism due to pituitary metastasis. Surgical removal and whole brain radiation therapy were performed, but a portion of viable tumor remained. Only taking lapatinib, the size of the metastatic lesion began to shrink. Trastuzumab may have controlled the micro-metastasis of breast cancer, but it was unable to control its progression to the central nervous system. Lapatinib is a possible option for HER2-positive metastatic breast cancer patients with brain metastasis.

Keyword

Breast neoplasms; Neoplasm metastasis; Hypopituitarism; HER2

MeSH Terms

Adult
Blood-Brain Barrier
Brain
Breast Neoplasms*
Breast*
Central Nervous System
Chemotherapy, Adjuvant
Cyclophosphamide
Doxorubicin
Female
Humans
Hypopituitarism
Mastectomy, Simple
Neoplasm Metastasis*
Cyclophosphamide
Doxorubicin

Figure

• 

  Fig. 1. Magnetic resonance imaging of metastatic pituitary lesion. (A) At the time of diagnosis, a 35-mm strongly enhancing mass was observed in the sellar and suprasellar regions (September 2012). (B) Even after partial removal of the tumor via craniotomy and whole brain radiation therapy, viable tumor remained (27 mm, November 2012). (C) The size of the enhancing lesion had increased slightly (29 mm) 4 months after discontinuation of lapatinib and capecitabine due to gastrointestinal sepsis (June 2013). (D) After re-starting lapatinib monotherapy, the size of the enhancing mass decreased (25 mm, September 2013).

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  Fig. 2. (A) Histology of invasive ductal carcinoma showing a predominantly trabecular pattern, high nuclear atypia, and high mitotic activity (H&E staining, ×100). (B) Histology of invasive ductal carcinoma metastasis to the brain, showing infiltration of malignant cells to the parenchyma (H&E staining, ×100).

• 

  Fig. 3. Due to gastrointestinal sepsis, the patient’s serum sodium level changed radically (March to April, 2013), and it was stabilized after the tumor was controlled by lapatinib (November 2013).

Reference

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