Mini Review, Clin Oncol Case Rep Vol: 4 Issue: 8
Clinical Experience Beyond Clinical Data on Breast Cancer – Case Report
Amalia Mara Rosu*
Department of Oncology, Ponderas Academic Hospital, Hospital in Bucharest, Romania.
*Corresponding Author: Adamantia Nikolaidi,
Department of OncologyPonderas Academic Hospital, Hospital in Bucharest, Romania.
E-mail: Amalia.mara@yahoo.com
Received: August 05, 2023; Manuscript No: COCR-23-109295;
Editor Assigned: August 07, 2023; PreQC Id: COCR-23-109295 (PQ);
Reviewed: August 16, 2023; QC No: COCR-23-109295 (Q);
Revised: August 18, 2023; Manuscript No: COCR-23-109295 (R);
Published: August 21, 2023; DOI: 10.4172/cocr.6(8).305
Citation: Rosu AM (2023) Clinical Experience Beyond Clinical Data on Breast Cancer - Case Report. Clin Oncol Case Rep 6:8
Abstract
This case report presents the clinical history, treatment, and response of a 59-year-old female patient diagnosed with metastatic breast cancer. The patient exhibited a delayed diagnosis due to refusal of a biopsy, leading to an advanced stage of the disease. Initial evaluation revealed a voluminous malignant breast tumor with axillary adenopathies and liver metastases. First-line therapy consisting of ribociclib and letrozole was initiated, resulting in a positive response with significant reductions in tumor size, complete remission of liver lesions, and improvement in overall well-being. The combination of ribociclib and letrozole demonstrated effectiveness and manageable toxicities in treating hormone receptor-positive, HER2-negative metastatic breast cancer.
Keywords: Breast cancer, Tumor, Ribociclib, First-line therapy, HER-2
Introduction
Metastatic breast cancer is an advanced stage of the disease requiring systemic therapies for management. Early diagnosis is essential, but some patients may present challenges in obtaining a biopsy, leading to delayed recognition of the malignancy. This case report describes the clinical journey of a patient diagnosed with metastatic breast cancer after three years of neglected biopsy. The patient demonstrated a positive response to first-line therapy with ribociclib and letrozole, resulting in remarkable tumor regression and remission of metastatic liver lesions. We discuss the efficacy and safety profile of the ribociclib and letrozole combination in managing hormone receptor-positive, HER2-negative metastatic breast cancer [1].
Case Presentation
Clinical history
The patient, MA, a 59 year-old female, presented with a diagnosis of metastatic breast cancer. The primary tumor was identified in 2017 by self-deceleration. she started specific senological investigationultrasound and mammography (BIRADS 4), puncture biopsy of the left breast was recommended but the patient refuses to perform. In January 2020 she developed dimensional tumor growth accompanied by the abnegation of the tumor. The patient had no significant comorbidities and had a performance status of 1.
Evaluation at baseline
Evaluation at baseline was made through Bilateral mammary ultrasound-tegumentary edema of the entire left breast, nodules of permeation, hypervascularized voluminous formation with multiple echoes, with development from the skin it invades, to the deep planes; the formation extends to the posterior axillary line and has permeation nodules at this level as well in the armpit bulky adenopathic blocks-BIRADS5, Breast MRI multicenter tumor masses left breast with MRI appearance suggestive of malignancy-BIRADS6. Axillary, left retropectoral adenopathies (stations I, II and III) and internal left breast BIRADS 6 left breast Mammography + Bilateral Tomosynthesis left breast with overall reduced volume (retracted), marked diffuse skin thickening (thickness of about 8 mm); at the CC and CSE level voluminous opacity, with irregular shape and contours, having diameters of approximately 85 mm/45 mm, with malignant characters (biopsied), extended from the level of the retracted nipple to the level of the pectoral muscle (on certain portions without the delimitation interface to it); and with the presence of an outbreak of suspicious microcalcifications in the supero-external paraareolar portion, of about 16 mm/30 mm, with extension at the level of the skin. Left axillary lymphoganglionary opacities suggestive of suspicious adenopathies. Voluminous opacity with malignant characters, which associates nipple retraction; focus of microcalcifications, cutaneous thickening and axillary adenopathies (Figure 1).
Figure 1: Voluminous opacity with malignant characters, which associates nipple retraction; focus of microcalcifications, cutaneous thickening and axillary adenopathies.
We performed a biopsy with thick needle left breast tumor with a BHP+IHC result: Invasive breast carcinoma NST moderately differentiated, G2, ER positive in 98%, positive PGR in 75%, Negative HER2 (1+), ki 67 positive in 60%, Biopsy puncture left axillary adenopathy lymphoganglionara metastasis and the clinical examination showed. The left breast presents edema and erythema of high intensity of the skin of the external quadrants, dominant superoexternal quadrant: firm tumor formation, cauliflower, ulcerated with elimination of necrotic detritus and secretion of reduced sanguinolence quantities, approximately 12/10 cm adhesion to the deep planes; permeation nodules with diameters between 1 cm to 2.5 cm with the supraiacent red purplish tegument; left axillary shows voluminous, fixed adenopathic blocks (Figure 2).
Figure 2: Initial Local Exam.
The metastatic disease was confirmed through CT SCAN - insufficiently characterizable liver lesions, uncertain bone lesionsLeft mammary tumor formation with satellite lesions and left axillary adenopathies. Bone scintigraphy 02.2020 without secondary bone lesions. MRI examination of abdomen and pelvis 02.2020- multiple liver nodules (about 7) that show post-administration enhancement constrated located in segments II, IV and VII. The diagnosis was further supported by a liver biopsy, which confirmed secondary liver lesions originating from breast carcinoma with the same immunohistochemical characteristics between 12.02.2020-16.02.2020 the patient is hospitalized on the internal medicine department, presenting physical asthenia, effort dyspnea, palpitations, pain in the left breast. Bioumoral severe feripriv anemic syndrome (Hb=8g/dl), inflammatory syndrome, without liver cytolysis, normal lipid profile. she followed the treatment of rebalancing, pain reliever, transfusion treatment 4 units erythrocytic mass and I decided to initiate the treatment.
Treatment
The patient was initiated on first-line therapy consisting of ribociclib, a cyclin-dependent kinase 4/6 (CDK4/6) inhibitor, in combination with letrozole, an aromatase inhibitor. Ribociclib was administered at a dose of 600 mg (three film-coated tablets of 200 mg), administered once daily for 21 consecutive days, while letrozole was given at a dose of 2.5 mg once daily. The patient was closely monitored for treatment response, toxicity, and disease progression throughout the course of therapy.
Response to treatment
The patient demonstrated a positive response to the first-line therapy with ribociclib and letrozole. Follow-up imaging studies showed a significant reduction in the size of metastatic lesions if in 02.2020 the irm examination showed multiple liver nodules about 7 located in segments II, IV and VII in 8 2021 the irm examination showed a small hypocaptant lesion without restrictive of the water diphysia, currently of 4 mm, is found at the level of segment VII; the other liver lesions in segment II, IV at the limit with segment VIII and segment VII in 08.2022. No intrahepatic localized processes were found complete answer and Chest CT scan without secondary determinations (Figure 3).
Figure 3: Local exam during the treatment (2020-present)-almost complete response to the lesion described in the left breast.
Considering the response to the treatment
Almost complete response to the lesion described in the left breast, while at the level of the liver it was observed complete response,the local treatment can be taken into account between 08.11.2021- 22.11.2021. I performed external radiotherapy in the total dose per target volume of the left breast and ganglion stations, followed by the boost in the left breast up to a total dose of 59.4 Gy 33 fractions using the IMRT VMAT technique well-being and the treatment was generally well-tolerated, she presented neutropenia, leukopenia but without significant treatment delays or dose changes. The patient was very pleased with the treatment and had no restrictions in everyday life (Figure 4).
Figure 4: Treatment plan for external radiotherapy-target volume of the left breast and ganglion stations, followed by the boost in the left breast using the IMRT VMAT technique (archtherapy with volume modulation of the intensity).
Discussion
Metastatic breast cancer represents an advanced stage of the disease, and the management primarily focuses on systemic therapies. The combination of ribociclib and letrozole has been established as an effective first-line treatment option for postmenopausal patients with hormone receptor-positive, HER2-negative metastatic breast cancer. Ribociclib acts by inhibiting CDK4/6, which plays a crucial role in cell cycle progression, thereby preventing tumor cell proliferation. Letrozole, an aromatase inhibitor, reduces estrogen production and suppresses the growth of hormone-dependent breast cancer cells [1, 2].
The combination of ribociclib and letrozole has shown significant clinical benefits, including improved progression-free survival and overall response rates, as demonstrated in clinical trials. Moreover, the regimen has exhibited a favorable safety profile, with manageable toxicities such as neutropenia, leukopenia, and fatigue [3].
Conclusion
In conclusion, the patient, who neglected to perform a breast biopsy, being diagnosed 3 years later with metastatic breast cancer, demonstrated a positive response to first-line therapy comprising ribociclib and letrozole. The treatment resulted in a the decrease in the size of the breast tumor until disparity, the disappearance of left axillary adenopathies, the remission of secondary liver determinations and an improvement in the patient's overall condition. The patient is very pleased with the treatment and had no restrictions in everyday life and the success of the treatment is long-lasting, without significant treatment timings ongoing monitoring and follow-up are essential to assess treatment efficacy, manage any potential side effects, and make informed decisions regarding subsequent treatment strategies.
References
- Hortobagyi GN, Stemmer SM, Burris HA, Yap YS, Sonke GS, et al. (2016) Ribociclib as first-line therapy for HR-positive, advanced breast cancer. Eng J Med 375: 1738-1748. [Google Scholar] [Cross Ref]
- Finn RS, Martin M, Rugo HS, Jones S, Im SA, et al. (2016) Palbociclib and letrozole in advanced breast cancer. Eng J Med 375: 1925-1936. [Google Scholar] [Cross Ref]
- Sharma P, Abramson VG, O'Dea A, Cobleigh MA (2017) First-line therapy in post-menopausal women with hormone receptor-positive and HER2-negative metastatic breast cancer: A systematic review. Breast Cancer Res Treat. 166: 797-808. [Google Scholar] [Cross Ref]
