Treating breast cancer with trabectedin: a new arsenal.

disappeared for 2 days, before reappearing. The trough plasma erlotinib level was 224 ng/ml at day 7 after erlotinib intake. Utilizing a biweekly schedule, a rapid and sustained complete neurological remission was observed and maintained for 6 months. Grade 2 rash and diarrhea were the worse toxicities. Mean trough plasma erlotinib level before each intake was 439 ng/ml (n = 12; range 251–761). Pulmonary disease progression occurred and reintroduction of chemotherapy was concomitantly required to control both meningeal and extrameningeal disease. Recently, Kuiper et al. showed that a weekly, high dose of erlotinib is not effective in patients with acquired extracranial disease treated with a standard dose of erlotinib [3]. The higher plasma peak of erlotinib obtained with the biweekly schedule probably generated therapeutic concentrations in CSF. Although the biweekly schedule did not generate the suggested trough plasma therapeutic range (848–1684 ng/ml) for the control of pulmonary disease [4], our case illustrates that a biweekly, high dose of erlotinib could be a feasible regimen to achieve rapid and sustained meningeal disease control. Ethical considerations were central in the decision-making process. We suggest that physicians should consider LM as a distinct entity, thus being ready to reinforce its treatment and be open to combine concomitant specific treatments for both LM and extrameningeal disease.