Division of Breast Surgery, Department of Surgery.
Division of Breast Surgery, Department of Pathology, University of Kosin College of Medicine, Kosin University Gospel Hospital, Busan, Korea.
Medicine (Baltimore). 2021 Apr 9;100(14):e25175. doi: 10.1097/MD.0000000000025175.
Neo-adjuvant systemic therapy includes endocrine therapy and chemotherapy, which is widely used. Luminal breast cancer is resistant to chemotherapy and is more likely to not respond to chemotherapy before surgery. Palbociclib is a cyclin-dependent kinase 4 and 6 inhibitor. Palbociclib with letrozole combination therapy was an effective chemotherapy in metastatic luminal type breast cancer and had fewer side effects; however, the benefit of palbociclib in neoadjuvant systemic therapy is unclear.
A 50-year-old female patient visited our hospital with palpable lump in the right breast. The lymph nodes fixed in the ipsilateral axilla.
The patient was diagnosed with invasive ductal carcinoma of the right breast; the nuclear grade was moderate. The ipsilateral fixed lymph node was diagnosed as metastasis. The breast cancer subtype was luminal A type and was positive for estrogen receptor and progesterone receptor, and negative for HER2/neu and Ki-67 marker index <10% on immunohistochemistry.
Neo-systemic therapy was performed with 3 cycles of adriamycin with docetaxel. After follow-up study, the breast and axillary lesions progressed. Palbociclib with letrozole was administered as second neo-systemic therapy for 10 months. Subsequently, breast-conserving surgery with sentinel lymph node biopsy was performed.
In the postoperative pathologic result, 4 mm invasive lesion remained, and the sentinel lymph node biopsy was negative. The results achieved a residual cancer burden classification class 1.
Second-line neo-systemic therapy can further reduce the size of the tumor and increase the likelihood of avoiding the side effects of surgery. Palbociclib with letrozole may be a good treatment in the preoperative stage for luminal breast cancer that is resistant to chemotherapy.
新辅助全身治疗包括内分泌治疗和化疗，应用广泛。腔腺癌对化疗耐药，术前更有可能对化疗无反应。哌柏西利是一种细胞周期蛋白依赖性激酶 4 和 6 抑制剂。哌柏西利联合来曲唑的联合治疗在转移性腔型乳腺癌中是一种有效的化疗药物，且副作用较少；然而，哌柏西利在新辅助全身治疗中的获益尚不清楚。
一名 50 岁女性因右乳可触及肿块就诊于我院。同侧腋窝淋巴结固定。
患者被诊断为右乳浸润性导管癌；核级为中级别。同侧固定淋巴结诊断为转移。乳腺癌亚型为腔 A 型，雌激素受体和孕激素受体阳性，免疫组化 HER2/neu 和 Ki-67 标志物指数均为阴性。
行 3 周期多柔比星联合多西紫杉醇新辅助全身治疗。随访后，乳腺和腋窝病变进展。给予哌柏西利联合来曲唑进行二线新辅助全身治疗 10 个月。随后，进行保乳手术联合前哨淋巴结活检。
术后病理结果示仍有 4mm 浸润性病变，前哨淋巴结活检阴性。结果达到残留肿瘤负荷分类 1 级。
二线新辅助全身治疗可进一步缩小肿瘤大小，增加避免手术副作用的可能性。对于化疗耐药的腔腺癌，哌柏西利联合来曲唑可能是术前的一种较好治疗方法。
