Journal of Clinical Oncology, Vol 21, Issue 11
(June), 2003: 2215-2216
© 2003 American Society for Clinical Oncology
Unusual Problems in Breast Cancer and a Rare Lung Cancer Case
Case 1. Clinical Complete Response of Breast Cancer Metastases After Trastuzumab-Based Immunotherapy
Giuseppe Tonini,
Bruno Vincenzi,
Daniele Santini,
Giuseppe Avvisati,
Annalisa La Cesa,
Alfonso Baldi
Università Campus Bio-Medico, Rome, Italy; and Regina Elena Cancer Institute, Rome, Italy
A 60-year-old Italian woman was diagnosed in December 1997 with undifferentiated right breast cancer infiltrating the skin. Preoperative clinical evaluation for distant metastases yielded negative results, and both pre- and postoperative serum tumor markers were in the normal range. After radical right mastectomy and axillary lymph-node dissection, her stage was pT4b, pN1bii, and she received four courses of doxorubicin and six courses of standard cyclophosphamide, methotrexate, and fluorouracil (days 1 and 8). At the end of adjuvant chemotherapy, she received local standard radiotherapy and then was placed on tamoxifen. Because of poor compliance, tamoxifen was discontinued after 3 months. In January 2000, a nodule near the scar was identified during physical examination. Pathologic examination of a fine-needle aspiration revealed local recurrence. The nodule was surgically removed, and antineoplastic chemotherapy with cyclophosphamide, epirubicin, and fluorouracil was administered for a total of three courses. In January 2001, a new subcutaneous nodule occurred and was removed. Pathologic examination showed metastatic breast carcinoma. The patient refused chemotherapy, and 3 months later (April 2001), a new local recurrence occurred with the appearance of a large erythematous rash (15 x 15 cm), with multiple small nodules over the right side of the chest reaching the posterior axillary line. Because of the progression of disease, she was treated with weekly vinorelbine (25 mg/m2) as a single agent. Because of local progressive disease, this treatment was discontinued after seven courses in June 2001. Because the Hercept-test was positive (score 3+/3+) by immunohistochemistry, it was decided to start immunotherapy with trastuzumab, a recombinant humanized anti-p185HER-2 monoclonal antibody that binds with high affinity to the HER2 protein.1 Trastuzumab was administered weekly at 4 mg/kg as induction therapy and continued at 2 mg/kg, with good tolerance. At the beginning of immunotherapy, the erythematopapular skin relapse measured 20 x 20 cm (Fig 1A , 1B, and 1C). After the first six courses of trastuzumab, a clinical complete regression was observed (Fig 1D, 1E, and 1F). The patient persists in remission almost 1 year later, still receiving trastuzumab.
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Fig 1. (A, B, C) At the beginning of immunotherapy, the erythematopapular skin relapse measured 20 x 20 cm. (D, E, F) After the first six courses of trastuzumab, a clinical complete regression was observed.
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The reported incidence of chest wall recurrence after radical mastectomy or breast-conserving surgery is between 5% and 32%.2,3 In the majority of patients (80% to 90%), recurrences are multiple at the time of appearance. With standard antineoplastic therapy, clinical complete regression of local relapse is rare, episodic, and short lasting. To the best of our knowledge, this is the first report of complete regression of local breast cancer recurrence induced by trastuzumab-based immunotherapy. We indicate that trastuzumab should be considered as a treatment option in those patients with locoregional recurrence who had a positive Hercept-test.
REFERENCES
1. Baselga J, Tripathy D, Mendelsohn J, et al: Phase II study of weekly intravenous recombinant humanized anti-p185HER2 monoclonal antibody in patients with HER2/neu-overexpressing metastatic breast cancer. J Clin Oncol 14:737–744, 1996[Abstract/Free Full Text]
2. Schmoor C, Sauerbrei W, Bastert G, et al: Role of isolated locoregional recurrence of breast cancer: Results of four prospective studies. J Clin Oncol 18:1696–1708, 2000[Abstract/Free Full Text]
3. Recht A, Gray R, Davidson NE, et al: Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: Experience of the Eastern Cooperative Oncology Group. J Clin Oncol 17:1689–1700, 1999[Abstract/Free Full Text]
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