case_images: PMC10806069_01
case_images: (A) Brain T1-WI MRI showing a PR of the left frontal lesion but progression of other LM lesions to stereotactic radiation therapy (5*6 Gy) followed by paclitaxel-trastuzumab-pertuzumab. (B) Brain T1-WI MRI showing a diffuse PR of LM to intra-CSF MTX (3*15 mg) followed by intra-CSF trastuzumab (150 mg) with concomitant IV pertuzumab. (C) Brain T1-WI MRI showing a diffuse PR of LM to WBRT (10*3 Gy) with concomitant IV trastuzumab-emtansine. (D) Brain T1-WI MRI showing a diffuse PR of LM to IV trastuzumab-deruxtecan.
case_images: fonc-13-1210873-g001.jpg
case_images: PMC10806069_01_fonc-13-1210873-g001.jpg
case_images: f1
case_images: T1-weighted imaging (T1-WI) and T2-weighted imaging (T2-WI), strongly enhanced after gadolinium injection, with multiple linear contrast-enhanced leptomeningeal lesions in the frontotemporal, peri-mesencephalic and peri-bulbar region ( Figure 1A ). There was no distant metastasis on the thoraco-abdominopelvic CT-scan. Despite a radiological partial response (PR) at 3 months on the left frontal lesion, other leptomeningeal lesions progressed, which was associated with a neurological decline (KPS = 50%, cognitive impairment, cerebellar syndrome) ( Figures 1A, B ). The patient experienced a durable neurological improvement (KPS = 80%) and could return home for 6 months ( Figure 1B ). A new line of systemic trastuzumab-emtansine (T-DM1) in monotherapy was initiated but showed no clinico-radiological benefit after 3 cycles ( Figure 1C ). T-DM1, resulting in a 3.5 months-PR when the patient could stay at home ( Figure 1C ). That improvement was followed by a neurological decline (KPS = 50%) and radiological progression of LM. Eventually, the LM progressed ( Figure 1D ) and a last treatment of IV trastuzumab-deruxtecan (T-DXd) resulted in a clinico-radiological PR at 3 months with stable neurologic symptoms (KPS = 50%) ( Figure 1D ).