West A, Friedman Kp, Muggia F
NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA.
Ecancermedicalscience. 2011;5:237. doi: 10.3332/ecancer.2011.237. Epub 2011 Dec 1.
Details on the 28-year treatment history of a patient with an endocrine-responsive breast cancer are provided. She was originally diagnosed as having a T1N0M0 cancer after a modified radical mastectomy at age 41. Fifteen years later, in 1998, she presented with hemoptysis and pleuritic chest pain: a 10 cm right atrial tumor and estrogen receptor (ER) positive endobronchial and adjacent lung parenchyma adenocarcinoma were documented. Epithelial markers normalized as she manifested a partial response (PR) lasting 3 years with tamoxifen treatment. From 2001 to 2007 she benefitted from exemestane treatment. Upon progression in the previous lung area and left adrenal, exemestane withdrawal led to transient decrease in markers. Six months later (in July 2008), with growth in her adrenal tumor, laparoscopic adrenalectomy was performed: in addition to ER positivity, the tumor showed Her2 overexpression and amplification. She has subsequently had some control of disease with fulvestrant, letrozole + trastuzumab, and subsequently letrozole + lapatinib. In addition to the chronicity of disease, this history illustrates the expanding range of treatments available for endocrine-responsive breast cancer commensurate to our greater understanding of tumor biology.
本文提供了一名内分泌反应性乳腺癌患者长达28年的治疗史详情。她41岁时接受改良根治性乳房切除术后最初被诊断为T1N0M0期癌症。15年后，即1998年，她出现咯血和胸膜炎性胸痛：记录显示右心房有一个10厘米的肿瘤，以及雌激素受体（ER）阳性的支气管内和相邻肺实质腺癌。在她接受他莫昔芬治疗表现出持续3年的部分缓解（PR）时，上皮标志物恢复正常。从2001年到2007年，她受益于依西美坦治疗。在前述肺部区域和左肾上腺出现进展时，停用依西美坦导致标志物短暂下降。6个月后（2008年7月），随着肾上腺肿瘤增大，进行了腹腔镜肾上腺切除术：除ER阳性外，肿瘤还显示Her2过表达和扩增。她随后通过氟维司群、来曲唑+曲妥珠单抗，以及随后的来曲唑+拉帕替尼对疾病进行了一定程度的控制。除了疾病的慢性病程外，这段病史还说明了随着我们对肿瘤生物学有了更深入的了解，内分泌反应性乳腺癌可用治疗方法的范围不断扩大。
