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Case report
peer-reviewed

Treatment of Minimal Residual Disease in Breast Cancer: A Longitudinal Case Study



Abstract

The presence of micrometastatic disease will ultimately determine the breast cancer-specific mortality of patients treated according to current guidelines. Minimal residual disease (i.e., occult tumor, not detected by conventional tests) may exist in two forms: a dormant form of only micrometastasis and a more aggressive “awakened” form where CTCs (circulating tumor cells) are actively disseminating. The hypothesis is that patients with CTCs have a more advanced or aggressive disease (that the cancer has “awoken” and there is active dissemination), whereas those patients with only micrometastasis have “dormant” disease and, although at risk of future relapse, may not do so for many years. This case study shows how determining the presence of both CTCs and bone marrow micrometastasis could be used to monitor disease activity and determine treatment changes before the appearance of metastatic disease.

Presented is the case of a 53-year-old postmenopausal woman who presented with a T2N1M0 invasive ductal breast cancer. She had been treated with partial mastectomy, axillary dissection, local radiotherapy, and adjuvant chemotherapy. As the cancer was estrogen receptor-positive, she was taking tamoxifen. Two years into treatment, she was assessed for minimal residual disease and was found to be positive for CTCs and bone marrow micrometastasis. Her treatment was changed to letrozole and differing bisphosphonates. The minimal residual disease was finally eliminated, and at 16 years post-initial treatment, there was no evidence of relapse.

The detection of minimal residual disease can be used to monitor treatment effect and change therapy in order to maintain the asymptomatic status of the patient and prevent disease progression.



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Case report
peer-reviewed

Treatment of Minimal Residual Disease in Breast Cancer: A Longitudinal Case Study


Author Information

Nigel P. Murray Corresponding Author

CTC Unit, Universidad Finis Terrae


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

I would like to thank Mrs. Ana Maria Palazuelos for her help in writing this paper.


Case report
peer-reviewed

Treatment of Minimal Residual Disease in Breast Cancer: A Longitudinal Case Study


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Case report
peer-reviewed

Treatment of Minimal Residual Disease in Breast Cancer: A Longitudinal Case Study

  • Author Information
    Nigel P. Murray Corresponding Author

    CTC Unit, Universidad Finis Terrae


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    I would like to thank Mrs. Ana Maria Palazuelos for her help in writing this paper.


    Article Information

    Published: July 27, 2017

    DOI

    10.7759/cureus.1521

    Cite this article as:

    Murray N P (July 27, 2017) Treatment of Minimal Residual Disease in Breast Cancer: A Longitudinal Case Study. Cureus 9(7): e1521. doi:10.7759/cureus.1521

    Publication history

    Received by Cureus: May 23, 2017
    Peer review began: May 31, 2017
    Peer review concluded: July 24, 2017
    Published: July 27, 2017

    Copyright

    © Copyright 2017
    Murray. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The presence of micrometastatic disease will ultimately determine the breast cancer-specific mortality of patients treated according to current guidelines. Minimal residual disease (i.e., occult tumor, not detected by conventional tests) may exist in two forms: a dormant form of only micrometastasis and a more aggressive “awakened” form where CTCs (circulating tumor cells) are actively disseminating. The hypothesis is that patients with CTCs have a more advanced or aggressive disease (that the cancer has “awoken” and there is active dissemination), whereas those patients with only micrometastasis have “dormant” disease and, although at risk of future relapse, may not do so for many years. This case study shows how determining the presence of both CTCs and bone marrow micrometastasis could be used to monitor disease activity and determine treatment changes before the appearance of metastatic disease.

Presented is the case of a 53-year-old postmenopausal woman who presented with a T2N1M0 invasive ductal breast cancer. She had been treated with partial mastectomy, axillary dissection, local radiotherapy, and adjuvant chemotherapy. As the cancer was estrogen receptor-positive, she was taking tamoxifen. Two years into treatment, she was assessed for minimal residual disease and was found to be positive for CTCs and bone marrow micrometastasis. Her treatment was changed to letrozole and differing bisphosphonates. The minimal residual disease was finally eliminated, and at 16 years post-initial treatment, there was no evidence of relapse.

The detection of minimal residual disease can be used to monitor treatment effect and change therapy in order to maintain the asymptomatic status of the patient and prevent disease progression.



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Create a free account to continue reading this article.

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Nigel P. Murray

CTC Unit, Universidad Finis Terrae

For correspondence:
nigelpetermurray@gmail.com

Nigel P. Murray

CTC Unit, Universidad Finis Terrae

For correspondence:
nigelpetermurray@gmail.com