title: Prolonged Response and Restoration of Functional Independence with Bevacizumab plus Vinorelbine as Third-Line Treatment for Breast Cancer-Related Leptomeningeal Metastases.
abstract: BACKGROUND
  Survival of patients with leptomeningeal metastases (LM) and impaired functional status is limited to several months, and rarely does neurological function improve with treatment.
  
  
  METHODS
  A 34-year-old female with hormone-negative and HER2-positive metastatic breast cancer was diagnosed with bulky radiographic LM 45 months after initial diagnosis. She was treated with intra-CSF trastuzumab followed by intra-CSF liposomal cytarabine; however, the cancer progressed 8 months after the diagnosis of LM. At the time of the third LM progression, the patient presented with a cauda equina syndrome and cerebellar impairment resulting in an inability to walk. She was treated with CNS-directed radiotherapy (lumbosacral and cerebellar) and bevacizumab plus vinorelbine. Rapid functional improvement occurred, and the patient regained the ability to walk and independently manage her daily activities. Twelve months later, she presented with rapid progression of the LM resulting in death within several weeks.
  
  
  CONCLUSIONS
  In radiographically defined bulky LM, the combination of systemic therapy and CNS-directed radiotherapy likely is more active than intra-CSF therapy only. In lieu of the rapid and significant improvement in neurological function combined with the prolonged response, bevacizumab alone or in combination with chemotherapy and CNS-directed radiotherapy may be considered in select patients with radiographically bulky breast cancer-related LM.
authors.affiliation: Breast Cancer Department, University Hospital - CHRU, Paris, France ; Neuro-Oncology, Department of Neurosurgery, University Hospital - CHRU, Paris, France ; Inserm U-1192, Proteomic, Inflammatory Response, Mass Spectrometry Laboratory (PRISM), Lille 1 University, Villeneuve D'Ascq, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Le Rhun
authors.affiliation: Department of Neurology Mazarin, Pitié-Salpétrière Hospital, Paris, France ; Department of Radiation Oncology, Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Taillibert
authors.affiliation: Department of Radiology, Oscar Lambret Center, University Hospital - CHRU, Paris, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Boulanger
authors.affiliation: Department of Neurosurgery, Roger Salengro Hospital, University Hospital - CHRU, Paris, France.
authors.forename: Fahed
authors.initials: F
authors.lastname: Zairi
authors.affiliation: Breast Cancer Department, University Hospital - CHRU, Paris, France ; Lille 2 North of France University, Lille, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bonneterre
authors.affiliation: Department of Neurology, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Wash., USA.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
keywords: Bevacizumab; Breast cancer; Leptomeningeal metastases; Neoplastic meningitis; Quality of life; Symptom control
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