for those w brain mets running out of options-- a case report

[Lani]

One case may not be enough evidence for your oncologist to justify TDM-1, but if there are other reasons to try TDM-1 …just food for thought

BMJ Case Rep. 2014 Aug 14;2014. pii: bcr2014205680. doi: 10.1136/bcr-2014-205680.
Activity of T-DM1 in HER-2 positive central nervous system breast cancer metastases.
Torres S1, Maralani P2, Verma S1.
Author information

Abstract
A 55-year-old woman with metastatic human epidermal growth factor receptor 2 (HER-2) positive breast cancer (BC) to the lungs and bones was diagnosed with central nervous system (CNS) metastases in November 2011. The MRI showed a right parietal lobe mass with adjacent leptomeningeal disease and several small bilateral cerebellar metastases. She was treated with whole brain irradiation (WBI), followed by capecitabine and lapatinib (December 2011-March 2013) and trastuzumab and lapatinib (May 2013-August 2013). Then, the brain MRI showed progression. In the absence of significant neurological symptoms, we postponed WBI and closely monitored for the development of neurological symptoms. Systemic treatment with trastuzumab emtansine (T-DM1), an antibody-drug conjugate composed of the cytotoxic agent DM1 conjugated to trastuzumab, was initiated in September 2013 to control systemic disease. Unexpectedly, after two cycles of treatment the brain MRI showed a decrease in size of CNS metastases. This case report suggests possible activity of T-DM1 in HER-2 positive BC with CNS metastases.
2014 BMJ Publishing Group Ltd.
PMID: 25123575 [PubMed - in process]

[annettchen]

I heard from my oncologist that they have also seen surprisingly good responses with T-DM1 with brain mets. I had been told that because it's such a large molecule, it would not pass the BBB, but looks like it might after all. Onc argued that the cancer may make the BBB less restrictive, and make passage possible even for a molecule as large as T-DM1.