Leptomeningeal disease in BRIP1-mutated pancreatic adenocarcinoma. BMJ Case Rep 2022 Jun 08;15(6)
Date
06/09/2022Pubmed ID
35675963Pubmed Central ID
PMC9185485DOI
10.1136/bcr-2022-249837Scopus ID
2-s2.0-85131627874 (requires institutional sign-in at Scopus site) 1 CitationAbstract
Leptomeningeal disease is rare in pancreatic cancer and prognosis remains poor. Mutation profiles are now directing therapy to improve survival. We describe a case of leptomeningeal and brain metastasis in BRCA1 interacting protein 1, or BRIP1-mutated pancreatic adenocarcinoma with progression through several lines of chemotherapy and immunotherapy. A woman in her late 50s presented with metastatic pancreatic adenocarcinoma on liver biopsy. She achieved complete response after modified FOLFIRINOX and started a poly (ADP-ribose) polymerase (PARP) inhibitor for a BRIP1 mutation. She had recurrence at 9 months and started pembrolizumab (programmed cell death protein 1, or PD-1receptor antibody) for tumour mutational burden of 10 muts/Mb. At 10 months, she presented with lower extremity weakness and back pain. MRI revealed leptomeningeal metastases from T11 to cauda equina roots and right occipital metastasis. Cerebrospinal fluid studies revealed elevated pressure (290 mm H2O) and protein (73 mg/dL) with negative cytology. Leptomeningeal carcinomatosis was diagnosed. She began palliative radiation but died at 11 months from initial diagnosis.
Author List
Yim E, Leung DAuthor
Eunji Yim MD Assistant Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdenocarcinomaAntineoplastic Combined Chemotherapy Protocols
Female
Humans
Meningeal Carcinomatosis
Pancreatic Neoplasms
