Progressively Enlarging Cerebellar Hematoma Concurrent with T-DM1 Treatment
| Autor: | Gabriel O.B. Gil, Marcelo D. Vilela, William T. Longstreth, Marco Antonio D. Filho, Hugo A.S. Pedrosa, Juliano M. Duarte |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Receptor ErbB-2 medicine.medical_treatment Breast Neoplasms Ado-Trastuzumab Emtansine Radiosurgery Lapatinib Capecitabine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Hematoma Breast cancer Cerebellar Diseases Trastuzumab medicine Humans Maytansine skin and connective tissue diseases Radiotherapy Brain Neoplasms business.industry Middle Aged medicine.disease Combined Modality Therapy Cerebral Angiography Radiation therapy chemistry Drug Resistance Neoplasm Trastuzumab emtansine 030220 oncology & carcinogenesis Female Surgery Neurology (clinical) Radiology business Magnetic Resonance Angiography 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | World Neurosurgery. 111:109-114 |
| ISSN: | 1878-8750 |
| Popis: | Background Trastuzumab emtansine, an antibody–drug conjugate commonly abbreviated as T-DM1, is accepted as effective therapy for trastuzumab-resistant metastatic HER2-positive breast cancer. T-DM1 significantly increases progression-free and overall survival when compared with lapatinib plus capecitabine in patients with HER2-positive breast cancer previously treated with trastuzumab and a taxane. Among the common side effects related to T-DM1, thrombocytopenia and mucosal hemorrhage are seen, although they are infrequently judged to be clinically significant. Intracranial hemorrhages are extremely rare, and only 3 cases of hematomas have been reported in association with T-DM1 and remote radiotherapy, 2 of them with progressive enlargement. Objective Herein we describe a patient who presented with a cerebellar hematoma that progressively enlarged over 8 months during treatment with T-DM1 and only a few months after whole-brain radiation therapy plus a stereotactic radiosurgery boost for a HER2-positive breast cancer cerebellar metastasis. The pathology of the hematoma was similar to that in previous cases and suggested a unique pathophysiology related to an interaction between T-DMI and radiation therapy. Conclusions A progressively enlarging intraparenchymal hematoma can be seen just a few months after delivery of radiation therapy for a metastatic brain lesion in HER2-positive breast cancer patients who are receiving T-DM1. In such patients, even a small focus of hemorrhage on magnetic resonance images should prompt close follow-up with serial imaging. |
| Databáze: | OpenAIRE |
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