Treatment of HER2-Positive Breast Cancer with Brain Metastases Using Anlotinib and Trastuzumab Deruxtecan: A Case Report

Figures & data

Figure 1 Brain contrast-enhanced magnetic resonance imaging (MRI) scans show brain metastases before and after anlotinib and T-DXd therapy. (A) brain metastases before anlotinib and T-DXd therapy; (B) partial response in brain metastases after anlotinib and T-DXd treatment.

Figure 2 Chest and abdominal enhanced computed tomography(CT) scans show lung metastases before and after anlotinib and T-DXd therapy. (A) lung metastases before anlotinib and T-DXd therapy; (B) partial response in lung metastases after anlotinib and T-DXd treatment.

Figure 3 Timeline of the clinical course in this patient.

Abbreviations: NAT, Neoadjuvant therapy; AT, adjuvant therapy; M, months; ECMs, extracranial metastases; BMs, brain metastases; PR, partial response; PD, progress disease; SD, stable disease; THP, albumin-bound paclitaxel, trastuzumab and pertuzumab; WBRT, whole brain radiotherapy; HP, trastuzumab and pertuzumab; Cap, capecitabine; Bav, bevacizumab; NVB, navelbine; SBRT, stereotactic radiotherapy; RC48, disitamab vedotin; T-DXd, trastuzumab deruxtecan.

Table 1 Summary of Current Clinical Trials Using Targeted Agents in Her2+ BCBM

Author & Published Time	Study	Therapy	Phase	Intracranial ORR	mPFS (Months)	mOS (Months)
Guy Jerusalem et al 2022 Oct^Citation22	DESTINY-Breast01 NCT03248492	T-DXd	II	58.3%	18.1	NA
José Manuel Pérez-García et al 2023. Jan^Citation8	DEBBRAH NCT04420598	T-DXd	II	46.2%	NA	NA
Rupert Bartsch et al 2022. Sep^Citation23	TUXEDO-1 NCT04752059	T-DXd	II	73.3%	14	NA
F Montemurro et al 2020 Oct^Citation5	KAMILLA NCT01702571	T-DM1	IIIb	21.4%	5.5	18.9
Nancy U Lin et al 2020 Aug^Citation14	HER2CLIMB NCT02614794	Tucatinib versus Placebo+Trastuzumab + Capecitabine	III	47.3% versus 20.0% (P=0.03)	9.9 versus 4.2 (P<0.0001)	18.1 versus 12.0 (P=0.005)
Min Yan et al 2022 Mar^Citation16	PERMEATE NCT03691051	Pyrotinib + capecitabine	II	74·6% in cohort A and 42·1% in cohort B	NA	NA
Sara A Hurvitz et al 2021 Aug^Citation20	NALA NCT01808573	Neratinib + capecitabine versus lapatinib + capecitabine	III	26.3% versus 15.4%	7.8 versus 5.5 (P=0.074)	16.4 versus 15.4 (p=0.635)
Thomas Bachelot et al 2013 Jan^Citation12	LANDSCAPE NCT00967031	Lapatinib + capecitabine	II	65·9%	5·5	17·0
Nancy U. Lin et al 2009 Feb^Citation11	NCT00263588	Lapatinib	II	6%	2.40	6.37
Rachel A Freedman et al 2019 May^Citation19	TBCRC 022 NCT01494662	Neratinib and Capecitabine	II	49% in cohort 3A and 33% in cohort 3B	5.5 in cohort 3A and 3.1 in cohort 3B	13.3 in cohort 3A and 15.1 in cohort 3B

Notes: cohort A: radiotherapy-naive HER2-positive brain metastases; cohort B: progressive disease after radiotherapy; cohort 3A: Lapatinib-naïve, cohort 3B: lapatinib-treated.

Abbreviations: ORR, objective response rate; mPFS, median progression-free survival; mOS, median overall survival; NA, not available; T-DXd, trastuzumab deruxtecan; T-DM1, ado-trastuzumab emtansine.

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