Durable clinical benefit of letrozole in leptomeningeal metastasis of breast cancer

Abstract

A case of a woman in her 60s with breast cancer, whose leptomeningeal metastasis (LM) of breast cancer improved remarkably with letrozole monotherapy, is reported. The patient complained of numbness of her left hand and hoarseness, followed by progressive asymmetric extremity weakness and a bladder and rectal disturbance. The patient had undergone surgery for left breast cancer 18 years earlier and was concerned about recurrence of breast cancer, but there were no typical findings with some imaging modalities. The third lumbar puncture showed the malignant cytology of breast cancer, and the patient was diagnosed with recurrent breast cancer. Her performance status was very poor, and it was difficult to administer systemic chemotherapy. Letrozole was started because immunohistochemistry was positive for estrogen and progesterone receptors. After 4 months of letrozole therapy, the symptoms improved gradually. LM has a poor prognosis, and there is little evidence on which to base treatment, but hormone therapy may be an option for LM when the tumor is hormone receptor-positive, slow growing, and has a small volume.

Endocrine therapy for the treatment of leptomeningeal carcinomatosis in luminal breast cancer: a comprehensive review

“…In this review we have gathered data showing that subsets of patients have almost double the median OS in BC-LMD [12,45] and that use of ET in LMD can achieve prolonged survival rates compared with the usual reported outcomes [46,47,[58][59][60][61][62][63][64]74]. Our statistical comparison showed significant differences between OS LMD, suggesting that risk stratification could help identifying the most suitable patients for ET.…”

“…We found nine clinical cases reporting 12 women with BC-LMD treated ET (Table 2) [46,47,[58][59][60][61][62][63][64]. Nine patients received multimodality treatment after LMD diagnosis in addition to ET, RT (7), ITT (4) and chemotherapy (5).…”

Prognostic factors and therapeutic perspectives of meningeal carcinomatosis in patients with breast cancer: A case report and review of the literature

“…Finally, the efficacy of the combination of therapeutic regimens, such as intrathecal topotecan combined with intravenous eribulin, has been demonstrated, showing radiological stability of the disease and slight clinical improvement without serious systemic toxicities [9]. Hormone therapy with tamoxifen, letrozole and examestane that, in cases of breast cancer with positive estrogen and progestogen receptors, slow growth and small size would favor an increase in survival without causing serious side effects [10] has also been considered. VEGF (the growth factor of the vascular endothelium) has been identified as an element of poor prognosis which would favor the dissemination of disease.…”