Good control of diffuse brain metastasis with lapatinib plus capecitabine in a patient with HER2-positive breast cancer

S We present the case of a patient affected by HER2-positive breast carcinoma, relapsed at supraclavicular and mediastinal lymph nodes level, after three and eight years from initial diagnosis. These relapses were successfully treated by local radiotherapy, hormone therapy and trastuzumab. After 10 years from onset, the patient developed cerebral progression with a number of seizable lesions, overt clinical symptoms. To avoid the short- and long-term side effects of whole brain radiotherapy, the patient is initially treated with lapatinib and capecitabine in light of the favorable data on the efficacy of this combination on brain metastases from HER2-positive breast carcinoma. This therapy results in a considerable lesions reduction, allowing to postpone the panencephalic radiotherapy to a later time with a lower tumor burden. The response to radiotherapy is significant and sustanined for a progression-free interval of about 10 months. This case suggests that lapatinib may represent the treatment of choice in cases of indolent disease, characterized by long progression free intervals with minor symptoms with the aim to postpone the use of more invasive treatments (Oncology).