# Cerebrospinal Fluid Testing in Leptomeningeal Progression of HER2-Negative Breast Cancer Reveals HER2 Positivity, Leading to HER2-Targeted Therapy: A Case Report

## TL;DR

A breast cancer patient initially tested HER2-negative but later showed HER2 positivity in cerebrospinal fluid, allowing effective targeted therapy and improved outcomes.

## Contribution

Demonstrates how rebiopsy and advanced testing can reveal evolving cancer markers for better treatment options.

## Key findings

- Cerebrospinal fluid testing identified HER2 positivity in a patient with initially HER2-negative breast cancer.
- Use of trastuzumab deruxtecan led to significant clinical improvement in the patient.
- Rebiopsy and next-generation sequencing can uncover new treatment opportunities in progressing cancers.

## Abstract

The treatment of breast cancer is largely determined by protein expression assays of estrogen receptor, progesterone receptor, and Her2/neu (HER2) status. These prognostic markers may vary due to tumor heterogeneityor the evolution of prognostic markers throughout the course of treatment. This report presents a case of a patient who initially presented with HER2-negative breast cancer and had rapidly progressed on numerous lines of treatment. An analysis of cerebrospinal fluid via next-generation sequencing and biopsy of metastasis to the liver identified HER2-positive cancer, which allowed for the use of trastuzumab deruxtecan, a HER2-targeted therapy. This led to an excellent clinical response with improvement in performance status and quality of life. This case report demonstrates the importance of continuing to follow a patient’s cancer pathology to open the doors for other opportunities for treatment. Cancer has the potential to evolve and there is a benefit of obtaining rebiopsies to ensure the correct targeted therapies are provided to the patient.