Honc: Late recurrence of breast CA

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Brain metastasis in HER2+ breast cancer treated with Herceptin • HER2-positive breast cancer patients may have significantly higher incidence of CNS metastasis after treatment with trastuzumab (Herceptin) • HER2+ tends for more aggressive phenotype • Trastuzumab overcame adverse prognostic significant of HER2 positivity • Large monoclonal antibody that does not cross the BBB • Improvement in systemic control and survival may led to “unmasking” of CNS disease recurrence • Brain may act as “sanctuary site” 42
Follow up • After completion of palliative whole brain radiation… ▫ Strength has improved remarkably ▫ Able to climb 27 stairs ▫ No nausea or headaches • Started on aromatase inhibitor 43
Page 1 and 2: Morning Report August 11, 2011 Nanc
Page 3 and 4: MKSAP Question On physical examinat
Page 5 and 6: MKSAP Question Which of the followi
Page 7: MKSAP Question Although most cases
Page 10 and 11: HPI Summary • Nausea and associat
Page 12 and 13: Oncologic History The patient had a
Page 14 and 15: Physical Exam • BP 100/52 Pulse 8
Page 16: Differential Nausea/Vomiting 16
Page 19 and 20: Labs 13.7 9.2 261 38.9 HbA1C 7.5 13
Page 21: Mechanism of Nausea and Emesis •
Page 24 and 25: 6 weeks later, returns to PCP…
Page 26 and 27: Indications for referral 26
Page 28 and 29: CT Abd/Pelv • Metastatic disease.
Page 30 and 31: MRI Head • Multiple lesions in th
Page 32 and 33: CT Chest • RUL pulmonary nodule h
Page 34 and 35: Brain metastasis • Any cancer can
Page 36 and 37: Sir William Richard Gowers (20 Marc
Page 38 and 39: Patient course • Started on oral
Page 40 and 41: Primary Tumor CTCs Bone Marrow Expa
Page 44 and 45: References • Keane JR. Neurologic

Honc: Late recurrence of breast CA

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