Intrathecal trastuzumab for the treatment of meningeal carcinomatosis in HER2-overexpressing metastatic breast cancer

Leptomeningeal carcinomatosis represents a rare manifestation of metastatic breast cancer (3.5 %); whereas the incidence of secondary meningeal seeding in patients suffering from parenchymal brain involvement is estimated as being up to 6 %. With a median survival of only few weeks, the prognosis of the affected patients is poor. There is initial evidence that penetration of trastuzumab into cerebrospinal fluid (CSF) is generally poor. 

In the present case report, we demonstrate that high levels of trastuzumab can also be achieved by direct application of trastuzumab into the CSF using an Ommaya reservoir. Particulars of the levels of trastuzumab in serum and CSF, determined quantitatively by a novel-type ELISA, are also given.
All intrathecal doses of trastuzumab were tolerated well and the patient’s condition improved significantly. Tumor cell counts in CSF obtained from the Ommaya reservoir remained low for 11 months after first diagnosis of meningeal carcinomatosis.
Intrathecal trastuzumab seems to be a promising approach for the treatment of HER2 positive meningeal carcinomatosis.

Bibliographic reference:

Stemmler HJ, Schmitt M, Harbeck N, Willems A, Bernhard H, Lassig D, Schoenberg S, Heinemann V.:"Application of intrathecal trastuzumab (Herceptintrade mark) for treatment of meningeal carcinomatosis in HER2-overexpressing metastatic breast cancer", Oncol Rep. 2006 May;15(5):1373-7

Joachim  Stemmler

Department of Internal Medicine III, Ludwig-Maximilians-University of Munich, Klinikum Grosshadern, Munich, Germany