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BACKGROUND Since the Cleopatra trial, the therapeutic standard for HER-metastatic breast cancer (BC) is combination of Pertuzumab, Trastuzumab and Docetaxel. Given the lack of availability of Pertuzumab in Tunisia, treating these diseases according to international recommendations remains a challenge. We report the case of a patient in which this protocol could be administered with favorable outcomes. CASE REPORT This observation is reporting the case of a luminal B-HER2 overexpressed BC in a 36 year-old woman. At presentation, radiological investigations revealed bone, hepatic, pulmonary, cerebral and meningeal metastasis. She was first treated with combination of Trastuzumab-Paclitaxel (8 courses)-Zoledronic Acid followed by whole brain radiotherapy (RT). A subsequent CT scan showed cerebral and hepatic complete response with pulmonary partial response. Thus, the patient was put on Tamoxifen with Trastuzumab as a maintenance treatment. 8 months later, the CA 15-3 level was rising without radiological progression. She had achieved surgical castration and the anatomopathological examination revealed ovarian metastasis. We rechallenged Paclitaxel with Trastuzumab and only 6 courses of Pertuzumab. Normalization of the CA 15-3 rate has been achieved. A relay by Anastrozole with Trastuzumab (Total of 27 injections) was done. The last workup concluded with a complete hepatic, pulmonary and cerebral response and a condensation of bone lesions. She is alive in excellent general condition 3 years after diagnosis. CONCLUSION Efforts by our health authorities are underway to offer anti HER therapies to comply with international standards. Meanwhile, this case has shown that thanks to continuous anti HER pressure with trastuzumab combined with only 6 injections of Pertuzumab, we have achieved prolonged survival in this patient. [ABSTRACT FROM AUTHOR]

BACKGROUND Medulloblastoma is a primitive neuroectodermal tumor (PNET) characterized by both radiosensitivity and chemosensitivity. Usually it occurs in the pediatric age while it remains unusual in adults. We report 2 cases of adult medulloblastoma in order to discuss epidemiological, clinical and therapeutic features of this rare entity. PRESENTATION OF CASES : Mr T. A., 22 years old, had in July 2014 an excisional surgery of a cerebellar mass and histopathology showed a grade IV desmoplastic medulloblastoma. The resection was macroscopically complete. He started adjuvant radiotherapy 45 days after surgery. He received a dose of 54 Gy on the tumor bed and 34 Gy on the cerebrospinal axis. The MRI performed at the end of the radiotherapy revealed a residual mass of 1.5 cm. The patient was classified as a high risk group. He had 6 cycles of Etoposide Carboplatin with complete response. He is in complete remission since 4 years. Mrs T.M, 30 years old, presented with a 3 months history of headaches and vomiting. At the end of the explorations, the diagnosis of grade IV desmoplatic medulloblastoma was established. She underwent surgical resection of a cerebellar mass with no tumoral margins. The examination of the cerebrospinal fluid during the initial workup could not be done, so the patient was classified in the high-risk group. Conclusion : Because adult medulloblastoma is not common, the optimal treatment strategy has not been established. More prospective trials are required to better define it. [ABSTRACT FROM AUTHOR]