Brain Metastases of Her2-Positive Breast Cancer: A Case of 34 Months’ Remission with Lapatinib plus Capecitabine

Breast tumors overexpressing Her2 (15% of breast cancers) are particularly at risk for central nervous system parenchymal metastases. Whole-brain irradiation (WBI) is the standard of care of brain metastases (BM), and secondarily, systemic treatment is used in case of progression. We report the case of a patient with Her2-positive breast tumor with BM developed 10 months after the initial diagnosis of cancer. The BM were initially treated with WBI then trastuzumab before a recurrence occurred, which was controlled during 34 months with lapatinib and capecitabine. The treatment was regularly adjusted according to the tolerance and the efficacy in order to obtain the control of systemic and neurological disease and to maintain the patient's quality of life. Studies on new targeted agents and/or new combinations with chemotherapy are ongoing. This suggests a better efficacy of treatment and an increased survival of patients. However, these patients are sometimes in a very poor general condition. In this case, we show that a good evaluation of efficacy and toxicities may allow an adaptation of the sequence and dose of treatment in order to preserve the response to treatment and the quality of life. Indeed, systemic treatments are available in addition to WBI. Therefore, the objective of the management of BM is twofold: survival and quality of life.