The unexpected effect of the combination of lapatinib and capecitabin in cranial metastasis.

Cranial metastasis (CM) is a serious problem in breast cancer patients. In patients with CM, quality of life is adversely affected and the survival of patients is reduced. It is also very difficult to manage breast cancer patients with cranial metastases whose life expectancy is generally 1 year or less. There is no case report in the literature of CM with more than 5 years of progression-free survival (PFS) with oncological treatment. I presented a rare case about the widespread CM developed with tamoxifen treatment in an advanced breast cancer patient who completed chemotherapy and radiotherapy after primary surgery. Systemic treatment was started as a combination of capecitabine and lapatinib after whole-brain radiotherapy was applied to the patient with extensive CM. At the end of about 3 years, there is complete response of cranial metastases, and PFS is over 5 years. The treatment was well tolerated, and she is still being followed up in the 74th month of this treatment without recurrence. There are no case reports of HER-2-positive breast cancer patients with such widespread cranial metastases in complete remission at 34 months of systemic therapy and 74 months of PFS. Our article is unique in this respect. It should be kept in mind that it is not appropriate to change the treatment plan of patients with only one case report. Although the options have increased with the use of new generation antihuman epidermal growth factor receptor 2 treatments, lapatinib can be a very effective treatment tool in selected patients.