Delayed neurotoxicity in HER2-positive breast cancer: a case series on combined SRS and T-DM1 treatment

• Published in: Frontiers in oncology Vol. 14; p. 1448593
• Main Authors: Turna, Menekse, Çağlar, Hale Başak
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 01.10.2024
• Subjects: brain metastasis; HER-2 breast cancer; Oncology; radionecrosis; stereotactic radiotherapy; trastuzumab emtansine; trastuzumab emtansine; brain metastasis; radionecrosis; stereotactic radiotherapy; HER-2 breast cancer
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2024.1448593

This case series presents four instances of late neurotoxicity observed in HER2-positive breast cancer patients with brain metastases following treatment with stereotactic radiosurgery (SRS) and subsequent trastuzumab emtansine (T-DM1) therapy. Despite initial control of intracranial disease, patients experienced neurological deterioration months to years post-treatment. Radiological assessments revealed distinct patterns consistent with radiation necrosis, particularly in areas previously treated with SRS and subsequent T-DM1 administration. These changes, characterized by enlarging cystic masses with hemorrhagic components, emphasize the importance of vigilant monitoring in patients undergoing combined SRS and T-DM1 therapy for brain metastatic breast cancer. This report underscores the need for further investigation into the long-term effects of combining SRS with novel systemic therapies, particularly in HER2-positive breast cancer patients with brain metastases. Understanding and mitigating late neurotoxicity are critical for optimizing treatment strategies and improving patient outcomes.