TY - JOUR T1 - Intrathecal trastuzumab: immunotherapy improves the prognosis of leptomeningeal metastases in HER-2+ breast cancer patient JF - Journal for ImmunoTherapy of Cancer JO - J Immunother Cancer DO - 10.1186/s40425-015-0084-y VL - 3 IS - 1 SP - 41 AU - Nu T. Lu AU - Jeffrey Raizer AU - Erwin P. Gabor AU - Natalie M. Liu AU - James Q. Vu AU - Dennis J. Slamon AU - John L. Barstis Y1 - 2015/12/01 UR - http://jitc.bmj.com/content/3/1/41.abstract N2 - We describe the clinical and therapeutic course of a 51-year-old woman with HER-2+ breast cancer who developed leptomeningeal (LM) and spinal cord metastases after 8 years of stable disease on combination therapy with intravenous (IV) trastuzumab. Due to progressive CNS disease, intrathecal (IT) trastuzumab was introduced to enhance HER-2+ therapy into the CSF space. A combination HER-2+ targeted approach achieved clinical remission with stable disease in our patient 46 months after she was diagnosed with LM metastases. However, spinal cord C-1 metastasis was not fully controlled with IT trastuzumab, ultimately leading to the patient’s respiratory compromise. In our patient, IT trastuzumab immunotherapy improved prognosis and was an effective strategy to manage HER-2+ LM disease. Given alone or alongside other anti-HER-2+ therapeutics with sufficient CNS penetration, IT trastuzumab could extend the lifespan of patients with leptomeningeal and CNS metastases.Abbreviations:HER-2HER-2/neu, Human epidermal growth factor receptor 2HER-2+/3+Human epidermal growth factor receptor 2/3 positiveLMLeptomeningeal metastasesIVIntravenousITIntrathecalCNSCentral nervous systemCSFCerebral spinal fluidC-1Cervival-1ADCCAntibody dependent cellular cytotoxicityIgG1Immunoglobulin G1NSABP B-31National Surgical Adjuvant Breast and Bowel Project Protocol 31BCIRG 006Breast Cancer International Research Group Study 006NCCTG N9831North Central Cancer Treatment Group Study N9831HERAHerceptin Adjuvant TrialNOAHNeoadjuvant Herceptin StudyNeo-ALTTONeoadjuvant Lapatinib and/or Trastuzumab Treatment Optimisation StudyT cellT lymphocytesT1N1M0Tumor node metastasis staging systemER/PR-Estrogen receptor/progesterone receptor negativeIACInternal auditory canalMRIMagnetic resonance imagingBIDTwice a dayCA27.29Cancer antigen 27.29T-DM1Trastuzumab emtansineCD8+Cluster of differentiation 8+RBCRed blood cellWBCWhite blood cellMgMilligramg/LGram per liter/cmm3Per cubic millimeter cubed = microliter ER -