Sadek Ibrahim, Keaton Mark, Maihle Nita J, Tang Shou-Ching
Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin 300060, China.
Genes Dis. 2017 Aug 3;4(3):159-162. doi: 10.1016/j.gendis.2017.07.007. eCollection 2017 Sep.
The human epidermal growth factor receptor 2 (HER2) is overexpressed in 25%-30% of breast cancer patients. Anti-HER2 therapies have changed the aggressive course of HER2+ breast cancer. In spite of the therapeutic benefits, their cardiotoxicities are major concerns, especially when used concurrently with anthracyclines. Here we present an elderly patient with relapsed HER2+ breast cancer. Her presentation for relapsed disease was unusual for the physical finding as well as the history of trastuzumab-induced severe cardiotoxicity while requiring additional anti-HER2 therapy. She received neoadjuvant anti-HER2 treatment for stage III breast caner. Due to severe reduction of cardiac ejection fraction (EF), she only received five doses of adjuvant transtuzumab. Unfortunately her disease relapsed one year later with chest wall lesions and a persistent low EF. We treated the patient with lapatinib combined with capecitabine which resulted rapid resolution of her chest wall lesion. More importantly, the patient had one year of disease control without deterioration in her ejection fraction. We discussed the management of recurrent HER2+ breast cancer with chest wall disease and the choice of anti-HER2 therapy in patients with a history of transtuzumab-induced cardiac dysfunction.
人表皮生长因子受体2（HER2）在25%-30%的乳腺癌患者中呈过表达。抗HER2治疗改变了HER2阳性乳腺癌的侵袭性病程。尽管有治疗益处，但其心脏毒性是主要关注点，尤其是与蒽环类药物同时使用时。在此，我们报告一名复发性HER2阳性乳腺癌老年患者。她复发疾病的表现无论在体格检查还是曲妥珠单抗诱导的严重心脏毒性病史方面都不寻常，同时需要额外的抗HER2治疗。她接受了新辅助抗HER2治疗用于III期乳腺癌。由于心脏射血分数（EF）严重降低，她仅接受了五剂辅助曲妥珠单抗治疗。不幸的是，一年后她的疾病复发，出现胸壁病变且EF持续偏低。我们用拉帕替尼联合卡培他滨治疗该患者，这使得她的胸壁病变迅速消退。更重要的是，患者疾病得到了一年的控制，射血分数没有恶化。我们讨论了复发性HER2阳性乳腺癌伴胸壁疾病患者的管理以及有曲妥珠单抗诱导的心脏功能障碍病史患者抗HER2治疗的选择。
