Palleschi Michela, Maltoni Roberta, Barzotti Eleonora, Melegari Elisabetta, Curcio Annalisa, Cecconetto Lorenzo, Sarti Samanta, Manunta Silvia, Rocca Andrea
Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola 47014, Italy.
Breast Surgery Unit, Ospedale Morgagni-Pierantoni, Forlì 47121, Italy.
World J Clin Cases. 2020 Feb 6;8(3):517-521. doi: 10.12998/wjcc.v8.i3.517.
Pathological complete response (pCR) is rare in hormone receptor-positive (HR+) HER2-negative breast cancer (BC) treated with either endocrine therapy (ET) or chemotherapy. Radical resection of locoregional relapse, although potentially curative in some cases, is challenging when the tumor invades critical structures. The oral cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with ET has obtained a significant increase in objective response rates and progression-free survival in patients with advanced BC and is now being evaluated in the neoadjuvant setting. We present a clinical case of a patient with an inoperable locoregional relapse of HR+ HER2-negative BC who experienced pCR after treatment with palbociclib.
We report the clinical case of a 60-year-old patient who presented with an inoperable locoregional relapse of HR+, HER2-negative BC 10 years after the diagnosis of the primary tumor. During a routine follow-up visit, breast magnetic resonance imaging and positron emission tomography/computed tomography revealed a 4-cm lesion in the right subclavicular region, infiltrating the chest wall and extending to the subclavian vessels, but without bone or visceral involvement. Treatment was begun with palbociclib plus letrozole, converting the disease to operability over a period of 6 mo. Surgery was performed and a pCR achieved. Of note, during treatment the patient experienced a very uncommon toxicity characterized by burning tongue and glossodynia associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. A reduction in the dose of palbociclib did not provide relief and treatment with the inhibitor was thus discontinued, resolving the tongue symptoms. Laboratory exams were unremarkable. Given that this was a late relapse, the tumor was classified as endocrine-sensitive, a condition associated with high sensitivity to palbociclib.
This case highlights the potential of the cyclin-dependent kinase 4/6 inhibitor plus ET combination to achieve pCR in locoregional relapse of BC, enabling surgical resection of a lesion initially considered inoperable.
在接受内分泌治疗（ET）或化疗的激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）乳腺癌（BC）中，病理完全缓解（pCR）很少见。局部区域复发的根治性切除虽然在某些情况下可能治愈，但当肿瘤侵犯关键结构时具有挑战性。口服细胞周期蛋白依赖性激酶4/6抑制剂帕博西尼联合ET已使晚期BC患者的客观缓解率和无进展生存期显著提高，目前正在新辅助治疗中进行评估。我们报告了1例HR+ HER2- BC局部区域复发且无法手术的患者，在接受帕博西尼治疗后实现pCR的临床病例。
我们报告1例60岁患者的临床病例，该患者在原发性肿瘤诊断10年后出现HR+、HER2- BC局部区域复发且无法手术。在常规随访期间，乳腺磁共振成像和正电子发射断层扫描/计算机断层扫描显示右锁骨下区域有一个4 cm的病灶，侵犯胸壁并延伸至锁骨下血管，但无骨或内脏受累。开始使用帕博西尼加来曲唑治疗，在6个月内使疾病转为可手术。进行了手术并实现了pCR。值得注意的是，在治疗期间，患者经历了一种非常罕见的毒性反应，表现为灼口和舌痛，伴有味觉障碍、感觉异常、感觉迟钝和口干。帕博西尼剂量减少并未缓解，因此停用该抑制剂，舌部症状得以缓解。实验室检查无异常。鉴于这是晚期复发，肿瘤被归类为内分泌敏感型，这与对帕博西尼高度敏感有关。
本病例突出了细胞周期蛋白依赖性激酶4/6抑制剂联合ET在BC局部区域复发中实现pCR的潜力，使最初认为无法手术的病灶能够进行手术切除。
