Ding Jingxian, Hu Pinghua, Chen Jun, Wu Xiaobo, Cao Yali
Department of Radiotherapy, Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang 330009, China.
Department of Breast Surgery, Breast Cancer Institute, The Third Hospital of Nanchang, Nanchang 330009, China.
Oncoscience. 2016 Sep 12;3(9-10):268-274. doi: 10.18632/oncoscience.320. eCollection 2016.
The discrepancy of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) statuses in breast cancers has been reported. Available systemic therapy for patients with breast cancer is based on the molecular subtypes as identified by IHC and/or FISH. However, these biomarkers may change throughout tumor progression.
We report a relatively uncommon case of a 39-year-old Chinese woman with local advanced breast cancer (LABC) treated with 6 cycles of docetaxel, doxorubicin and cyclophosphamide (TAC) regimen neoadjuvant chemotherapy, and subsequently mastectomy, intensity-modulated radiation therapy (IMRT) and tamoxifen followed as regularly. Brain metastatic event appeared in 6 months after mastectomy. Treatment for brain metastasis was surgical resection and followed by whole brain radiotherapy (WBRT) approved by multidisciplinary team (MDT). Initial pathological diagnosis was IDC, cT4N1M0, luminal B (ER+ 90%, PR+90%, HER2 0, Ki67+ 70%) based on ultrasound-guided core needle biopsy. Surgical pathology revealed IDC, pT2N3M0 luminal B (ER+ 20%, PR+20%, HER2 0, Ki67+ 20%). Histological response to neoadjuvant chemotherapy is grade 3 according to the Miller/Payne grading system. Final pathology of brain metastasis showed a HER2 overexpression metastatic breast cancer luminal B (ER+ 70%, PR+ 70%, HER2 2+, Ki67+ 30%), FISH confirmed HER2 overexpression. Weekly paclitaxel plus trastuzumab was given for 12 weeks, then trastuzumab every 3 weeks for a whole year. Patient follow-up is still ongoing, no new events appear yet.
The determination of hormone receptors and HER2 status should be routinely performed in all involved tissues, if possible, and systemic therapy should be tailored following the latest finding.
乳腺癌中雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（HER2）状态的差异已有报道。乳腺癌患者可用的全身治疗基于免疫组化（IHC）和/或荧光原位杂交（FISH）确定的分子亚型。然而，这些生物标志物可能会在肿瘤进展过程中发生变化。
我们报告了一例相对罕见的病例，一名39岁的中国女性患有局部晚期乳腺癌（LABC），接受了6个周期的多西他赛、阿霉素和环磷酰胺（TAC）方案新辅助化疗，随后进行了乳房切除术、调强放疗（IMRT）并按常规服用他莫昔芬。乳房切除术后6个月出现脑转移事件。脑转移的治疗是手术切除，随后是多学科团队（MDT）批准的全脑放疗（WBRT）。根据超声引导下的粗针活检，初始病理诊断为浸润性导管癌（IDC），cT4N1M0，腔面B型（ER+90%，PR+90%，HER2 0，Ki67+70%）。手术病理显示为IDC，pT2N3M0腔面B型（ER+20%，PR+20%，HER2 0，Ki67+20%）。根据Miller/Payne分级系统，新辅助化疗的组织学反应为3级。脑转移的最终病理显示为HER2过表达的转移性乳腺癌腔面B型（ER+70%，PR+70%，HER2 2+，Ki67+30%），FISH证实HER2过表达。给予每周一次的紫杉醇加曲妥珠单抗治疗12周，然后每3周一次曲妥珠单抗，持续一整年。患者随访仍在进行中，尚未出现新的事件。
如果可能，应在所有受累组织中常规检测激素受体和HER2状态，并应根据最新发现调整全身治疗方案。
