Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2024; 12(3): 575-581
Published online Jan 26, 2024. doi: 10.12998/wjcc.v12.i3.575
Inetetamab combined with pyrotinib and chemotherapy in the treatment of breast cancer brain metastasis: A case report
Qing-Qing Dou, Ting-Ting Sun, Guo-Qiang Wang, Wei-Bing Tong
Qing-Qing Dou, Ting-Ting Sun, Guo-Qiang Wang, Graduate Student Institute, Inner Mongolia Medical University, Hohhot 010000, Inner Mongolia Autonomous Region, China
Wei-Bing Tong, Central Breast Area B, Beijing University Cancer Hospital Inner Mongolia Hospital, Hohhot 010000, Inner Mongolia Autonomous Region, China
Author contributions: Dou QQ is the main contributor of this case, mainly responsible for case information collection; Sun TT and Wang GQ have the same contribution to the paper, mainly responsible for picture collection and content verification; Dou QQ integrated the content and wrote the manuscript; Tong WB was mainly responsible for the review and evaluation of the manuscript; all authors have commented on the previous version of the manuscript and approve the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and all accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Bing Tong, MD, Chief Physician, Surgeon, Central Breast Area B, Beijing University Cancer Hospital Inner Mongolia Hospital, No. 42 Zhaowuda Road, Saihan District, Hohhot 010000, Inner Mongolia Autonomous Region, China. tongwei365@qq.com
Received: October 26, 2023
Peer-review started: October 26, 2023
First decision: November 8, 2023
Revised: November 21, 2023
Accepted: January 2, 2024
Article in press: January 2, 2024
Published online: January 26, 2024
Processing time: 84 Days and 5.9 Hours
Abstract
BACKGROUND

Breast cancer brain metastasis (BCBM) is an advanced breast disease that is difficult to treat and is associated with a high risk of death. Patient prognosis is usually poor, with reduced quality of life. In this context, we report the case of a patient with HER-2-positive BCBM treated with a macromolecular mAb (inetetamab) combined with a small molecule tyrosine kinase inhibitor (TKI).

CASE SUMMARY

The patient was a 58-year-old woman with a 12-year history of type 2 diabetes. She was compliant with regular insulin treatment and had good blood glucose control. The patient was diagnosed with invasive carcinoma of the right breast (T3N1M0 stage IIIa, HER2-positive type) through aspiration biopsy of the ipsilateral breast due to the discovery of a breast tumor in February 2019. Immunohistochemistry showed ER (-), PR (-), HER-2 (3+), and Ki-67 (55-60%+). Preoperative neoadjuvant chemotherapy, i.e., the AC-TH regimen (epirubicin, cyclophosphamide, docetaxel-paclitaxel, and trastuzumab), was administered for 8 cycles. She underwent modified radical mastectomy of the right breast in November 2019 and received tocilizumab targeted therapy for 1 year. Brain metastasis was found 9 mo after surgery. She underwent brain metastasectomy in August 2020. Immunohistochemistry showed ER (-) and PR. (-), HER-2 (3+), and Ki-67 (10-20%+). In November 2020, the patient experienced headache symptoms. After an examination, tumor recurrence in the original surgical region of the brain was observed, and the patient was treated with inetetamab, pyrotinib, and capecitabine. Whole-brain radiotherapy was recommended. The patient and her family refused radiotherapy for personal reasons. In September 2021, a routine examination revealed that the brain tumor was considerably larger. The original systemic treatment was continued and combined with intensity-modulated radiation therapy for brain metastases, followed by regular hospitalization and routine examinations. The patient’s condition is generally stable, and she has a relatively high quality of life. This case report demonstrates that in patients with BCBM and resistance to trastuzumab, inetetamab combined with pyrotinib and chemotherapy can prolong survival.

CONCLUSION

Inetetamab combined with small molecule TKI drugs, chemotherapy and radiation may be an effective regimen for maintaining stable disease in patients with BCBM.

Keywords: Breast cancer brain metastasis; Resistance to trastuzumab; Macromolecule inetetamab; Small molecule tyrosine kinase inhibitor; Radiation therapy; HER2-positive; Case report

Core Tip: Herein, we report the case of a patient with complex breast cancer brain metastasis. She underwent brain metastasis resection and received macromolecular mAbs, small molecule tyrosine kinase inhibitors, combination chemotherapeutic drugs, and radiation therapy. The overall condition of the patient was controlled and stabilized. We propose that combined macromolecule and small molecule chemotherapy and radiotherapy can provide a new option for the treatment of patients with breast cancer brain metastases. Magnetic resonance imaging of the brain of the patient showed that the tumor size was stable, and all the tumor indicators were within the normal range.