Mirfakhraee Sasan, Chan Alberto V Cabo, Ganji Niloofar, Abramowitz Jessica
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
UT Southwestern Medical Center, WCB3 8th Floor, 2001 Inwood Rd, Dallas, TX, 75390, USA.
J Med Case Rep. 2021 Apr 29;15(1):207. doi: 10.1186/s13256-021-02792-8.
Adjuvant endocrine therapy is recommended for the treatment of hormone-receptor-positive breast cancer. Aromatase inhibitors are associated with significant musculoskeletal adverse effects, likely through growth hormone/insulin-like growth factor 1 modulation, while tamoxifen reduces insulin-like growth factor 1 production. We describe the case of a patient who was treated successfully with tamoxifen for her hormone-receptor-positive breast cancer and acromegaly.
A 57-year old White female with hormone-receptor-positive breast cancer was diagnosed with acromegaly. She received adjuvant endocrine therapy with anastrozole but could not tolerate this medication because of severe arthralgia, so she was switched to tamoxifen. Shortly after starting tamoxifen, the patient's musculoskeletal symptoms resolved and her insulin-like growth factor 1 levels normalized. She has remained in remission of her acromegaly and breast cancer since initiating tamoxifen.
This case highlights the dual benefit of tamoxifen therapy in the treatment of hormone-receptor-positive breast cancer and acromegaly. Unlike anastrozole, tamoxifen has the benefit of lowering insulin-like growth factor 1 levels, which underscores its advantage in reducing adverse musculoskeletal symptoms during the treatment of hormone-receptor-positive breast cancer. We offer the first reported use of tamoxifen monotherapy for the successful treatment of acromegaly and hormone-receptor-positive breast cancer. While tamoxifen may offer an additional, oral option for acromegaly patients who do not respond to or tolerate conventional growth-hormone-lowering therapy, additional studies are necessary.
辅助内分泌治疗被推荐用于激素受体阳性乳腺癌的治疗。芳香化酶抑制剂与显著的肌肉骨骼不良反应相关，可能是通过生长激素/胰岛素样生长因子1调节，而他莫昔芬可降低胰岛素样生长因子1的产生。我们描述了一名激素受体阳性乳腺癌患者成功接受他莫昔芬治疗并伴有肢端肥大症的病例。
一名57岁的白人女性，患有激素受体阳性乳腺癌，被诊断为肢端肥大症。她接受了阿那曲唑辅助内分泌治疗，但由于严重关节痛无法耐受该药物，因此改用他莫昔芬。开始使用他莫昔芬后不久，患者的肌肉骨骼症状缓解，胰岛素样生长因子1水平恢复正常。自开始使用他莫昔芬以来，她的肢端肥大症和乳腺癌一直处于缓解状态。
本病例突出了他莫昔芬治疗在激素受体阳性乳腺癌和肢端肥大症治疗中的双重益处。与阿那曲唑不同，他莫昔芬具有降低胰岛素样生长因子1水平的益处，这突出了其在激素受体阳性乳腺癌治疗中减少肌肉骨骼不良反应的优势。我们首次报道了他莫昔芬单药成功治疗肢端肥大症和激素受体阳性乳腺癌。虽然他莫昔芬可能为对传统降低生长激素治疗无反应或不耐受的肢端肥大症患者提供另一种口服选择，但仍需要进一步研究。
