Durable responses in patients with HER2+ breast cancer and leptomeningeal metastases treated with trastuzumab deruxtecan

Laura Alder; Dario Trapani; Claire Bradbury; Amanda E D Van Swearingen; Sara M Tolaney; Mustafa Khasraw; Carey K Anders; Christopher D Lascola; Liangge Hsu; Nancy U Lin; Sarah Sammons

doi:10.1038/s41523-023-00519-0

Durable responses in patients with HER2+ breast cancer and leptomeningeal metastases treated with trastuzumab deruxtecan

NPJ Breast Cancer. 2023 Mar 30;9(1):19. doi: 10.1038/s41523-023-00519-0.

Authors

Laura Alder^#¹, Dario Trapani^#^{2

3

4}, Claire Bradbury⁵, Amanda E D Van Swearingen¹, Sara M Tolaney^{2

3

4}, Mustafa Khasraw¹, Carey K Anders¹, Christopher D Lascola⁶, Liangge Hsu^{4

7}, Nancy U Lin^{2

3

4}, Sarah Sammons^{8

9

10

11}

Affiliations

¹ Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA.
² Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³ Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Department of Biostatistics, Duke Cancer Institute, Duke University, Durham, NC, USA.
⁶ Department of Radiology, Duke University, Durham, NC, USA.
⁷ Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
⁸ Division of Medical Oncology, Department of Medicine, Duke Cancer Institute, Duke University, Durham, NC, USA. [email protected].
⁹ Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. [email protected].
¹⁰ Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA. [email protected].
¹¹ Harvard Medical School, Boston, MA, USA. [email protected].

^# Contributed equally.

Abstract

Leptomeningeal metastases (LM) are a devastating complication of HER2 + metastatic breast cancer (MBC), with no effective treatments. In a case series of 8 patients with heavily pretreated HER2 + MBC and progressing LM, all 8 patients (100%) derived clinical benefit from Trastuzumab deruxtecan (TDXd), and 4 patients (50%) had an objective partial response based on formal neuroradiology MRI reads using the EORTC/RANO-LM Revised-Scorecard. T-DXd warrants further study in LM in HER2 + MBC and solid tumors where T-DXd may be active.