Intrathecal Trastuzumab Treatment of the Neoplastic Meningitis due to Breast Cancer: A Case Report and Review of the Literature

Table 1

Intrathecal treatments using trastuzumab, alone or in association with other agents.

Reference	Symptoms	WBRT	CSF before ITT		MRI	Intrathecal therapy	CSF after ITT		MRI	Clinical response	Toxicity
		before ITT	Proteins	Malignant C	before ITT		Proteins	Malignant C	after ITT
Stemmler et al.,; 2006[3]	♀ 39 Y; Headache, dizziness	+	Increased	+	No data	MTX 6 × 15 mg; + Ommaya; TST 5 mg, 10 mg, 15 mg, 20 mg, 20 mg	Low	−	No data	Improved	None
Platini et al.,; 2006 [4]	♀ 36 Y; Vertigo, amnesia, mental confusion	−	Increased	+	No data	MTX; Peridural PAC; 46 × 25 mg TST (17 mo); THI	Normal	−	No data	Stable	None
Colozzaet al.,; 2009 [5]	♀ 38 Y; Headache, dizziness, gait disorder	+	No lumbar punction		LMC+	Ommaya; 23 × 12.5 mg/3 weeks TST	No data	−	Stable	Improved	None
Ferrario et al.,; 2009 [6]	♀ 31 Y; Visual impairment, right ptosis, paralysis of the right facial nerve, and left foot drop	−	Normal	+	No data	Ommaya; TST 2 × 20 mg, 2 × 25 mg, 3 × 30 mg, TST 40 mg q3w × 8 mo; TST 40 mg q3w + thiotepa 10 mg × 6 mo TST 50 mg q3W + 12 mg THI × 13 mo	No data	−	Improvement	Complete recovery	None
Mego et al.,; 2011 [7]	♀ 43 Y; Dizziness, cranial nerves palsy.	+	Increased	−	LMC+	MTX 15 mg + CYT 24 mg + HDC 24 mg + 3 × 20 mg TST, 3 × 40 mg TST	Increased	−	No data	Improved	None
	♀ 39 Y; Headache, dizziness, cranial nerve palsies, vision disorders	+	Increased	+	LMC+	MTX 15 mg + CYT 24 mg + HDC 24 mg + TST 1 × 20 mg,  1 × 40 mg, 1 × 80 mg, 3 × 100 mg	No data	−		Improved	None
Oliveira et al.,; 2011 [8]	♀ 40 Y; Headache, vomiting, gait disturbance	+	No lumbar punction		LMC+; (CT scan exam)	TST 25 mg + PRD 25 mg × 25 doses (2 years)	No data		Partial response	Complete recovery	None

TST: trastuzumab, MTX: methotrexate, THI: thiotepa, HDC: hydrocortisone, PRD: prednisolone, CYT: cytarabine, MRI: magnetic resonance imaging, CSF: cerebrospinal fluid, mo: months, CT: computed tomography, WBRT: whole brain radiotherapy, ITT: intrathecal treatment, “+”: presence, “−”: absence, malignant C: malignant cells.