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Case report
peer-reviewed

Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer



Abstract

Patients with metastatic breast cancer involving the liver and brain often have short overall survival. Here, we report a case of de novo metastatic breast cancer with multiple liver metastases at initial diagnosis in February 2011 in a 35-year-old Caucasian female patient. The histology was poorly differentiated invasive ductal carcinoma (estrogen and progesterone receptor negative, HER2 positive) and the patient was negative for germline BRCA 1 and 2 mutations. Systemic therapy with trastuzumab and docetaxel was given for six months and then switched to trastuzumab only because of peripheral neuropathy. At that time, the patient was in complete clinical remission. She developed brain metastases in September 2012 and received whole-brain radiotherapy, which resulted in complete remission. While on continued trastuzumab, the primary tumor in the breast recurred in May 2016. A mastectomy was performed and afterwards systemic therapy was intensified (trastuzumab, pertuzumab, paclitaxel). At the last follow-up (March 06, 2017) no further recurrence was detected. This case illustrates that standard HER2-directed treatment might provide long-term disease control also in selected patients with unfavorable patterns of spread. The beneficial effect of whole-brain radiotherapy is not necessarily limited to symptom palliation.



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Case report
peer-reviewed

Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer


Author Information

Carsten Nieder Corresponding Author

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

Bård Mannsåker

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

Ellinor Haukland

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. issued approval n/a. No clinical study, case report only (approved by the patient). Conflicts of interest: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer


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Case report
peer-reviewed

Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer

  • Author Information
    Carsten Nieder Corresponding Author

    Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

    Bård Mannsåker

    Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

    Ellinor Haukland

    Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. issued approval n/a. No clinical study, case report only (approved by the patient). Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: June 29, 2017

    DOI

    10.7759/cureus.1412

    Cite this article as:

    Nieder C, Mannsåker B, Haukland E (June 29, 2017) Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer. Cureus 9(6): e1412. doi:10.7759/cureus.1412

    Publication history

    Received by Cureus: March 10, 2017
    Peer review began: March 20, 2017
    Peer review concluded: June 29, 2017
    Published: June 29, 2017

    Copyright

    © Copyright 2017
    Nieder et al. 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

Patients with metastatic breast cancer involving the liver and brain often have short overall survival. Here, we report a case of de novo metastatic breast cancer with multiple liver metastases at initial diagnosis in February 2011 in a 35-year-old Caucasian female patient. The histology was poorly differentiated invasive ductal carcinoma (estrogen and progesterone receptor negative, HER2 positive) and the patient was negative for germline BRCA 1 and 2 mutations. Systemic therapy with trastuzumab and docetaxel was given for six months and then switched to trastuzumab only because of peripheral neuropathy. At that time, the patient was in complete clinical remission. She developed brain metastases in September 2012 and received whole-brain radiotherapy, which resulted in complete remission. While on continued trastuzumab, the primary tumor in the breast recurred in May 2016. A mastectomy was performed and afterwards systemic therapy was intensified (trastuzumab, pertuzumab, paclitaxel). At the last follow-up (March 06, 2017) no further recurrence was detected. This case illustrates that standard HER2-directed treatment might provide long-term disease control also in selected patients with unfavorable patterns of spread. The beneficial effect of whole-brain radiotherapy is not necessarily limited to symptom palliation.



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Create a free account to continue reading this article.

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Carsten Nieder

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

For correspondence:
cnied@hotmail.com

Bård Mannsåker

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

Ellinor Haukland

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

Carsten Nieder

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

For correspondence:
cnied@hotmail.com

Bård Mannsåker

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust

Ellinor Haukland

Dept. of Oncology and Palliative Medicine, Nordland Hospital Trust