First-line Therapy with Lapatinib (Tykerb(superscript ®)) in Metastatic Breast Cancer that Progressed on Adjuvant Trastuzumab (Herceptin(superscript ®)) Treatment: Report of a Case

對於先前接受過其他化學藥物治療但仍惡化的晚期或轉移陸HER2(+)乳癌而言，Lapatinib是一項新的治療選擇。本篇個案報告中，我們提供一位50歲第Ⅱ期、T3N0M0、ER(-)、PE(-)及HER2(3+)之浸潤性乳腺管道癌的更年期女性個案患者在2007年3月2日接受皮膚保留乳房切除後，立即以組織擴張重建，之後只接受每3週一次的Trastuzumab的輔助治療（合計共2,640mg）。患者對Trastuzumab的整體反應良好，直到2008年6月出現肝轉移現象。考量到肝衰竭問題作者捨化學治療而嘗試使用比建議劑量低的lapatinib治療。第一週以750mg/平方公尺/day合併每天兩次Capecitabine (1,250mg/平方公尺)予以治療，患者的肝功能在一週治療後有所進步，因此將Lapatinib劑量調高為1,000mg/平方公尺/day。一個月後，轉移的腫瘤數量雖然沒有改變，但大部份的淋巴結病變得較不明顯，甚至幾乎看不見；四個月後，先前存在的肝轉移腫瘤顯著縮小，有些腫瘤則不再觀察得到；腫瘤變化反映出疾病完全緩解。此個案提供了Lapatinib有效治療對Trastuzumab無反應之HER2過度表現乳癌患者的臨床證據，未來需要更多以Lapatinib治療早期乳癌及其應用於第一線治療的相關研究。

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並列摘要

Lapatinib is a novel treatment option for female breast cancer patients who have HER2-positive advanced or metastatic breast cancer that has progressed after previous treatment with other chemotherapeutic agents. We report herein a 50-yearold perimenopausal female who had Stage IIB, T3N0M0, ER(-), PR(-), Her2(3+) breast infiltrating ductal carcinoma and had only received adjuvant trastuzumab therapy every three week of 2,640 mg given in total following skin sparing mastectomy with immediate tissue expander reconstruction on March 2nd, 2007. Her overall responses to trastuzumab were good until liver metastases were discovered in June, 2008. Due to hepatic failure, instead of chemotherapy we tried lapatinib at a dose lower than recommended. The patient received 750 mg/m^2/day of lapatinib for the first week, along with capecitabine (1,250 mg/m^2) twice a day. Her liver function showed improvement after one week of therapy, therefore we increased the dose of lapatinib to 1,000 mg/m^2/day. A month later, the number of metastasis tumors remained stationary in numbers, but most of the lymphadenopathy was less obvious and almost invisible. Four months later, significant shrinkage of the pre-existing hepatic metastases was observed, and some of the tumors were no longer detected which reflected complete remission from those tumors. This present case corresponds with the previous evidence that lapatinib has clinical activity in HER2-overexpressing breast cancer that is not responsive to trastuzumab-containing therapy. Future studies regarding the impact of lapatinib on earlier stages of breast cancer, as well as its application as first-line therapy, are warranted.

並列關鍵字

HER2 ； lapatinib ； metastatic breast cancer ； trastuzumab

國際替代計量

First-line Therapy with Lapatinib (Tykerb(superscript ®)) in Metastatic Breast Cancer that Progressed on Adjuvant Trastuzumab (Herceptin(superscript ®)) Treatment: Report of a Case

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