Isogai Ayaka, Kotani Haruru, Sawaki Masataka, Hattori Masaya, Yoshimura Akiyo, Kataoka Ayumi, Nozawa Kazuki, Ozaki Yuri, Endo Yuka, Nakakami Akira, Komaki Rie, Iwata Hiroji
Department of Breast Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan.
Surg Case Rep. 2023 Jun 21;9(1):112. doi: 10.1186/s40792-023-01661-4.
With advances in breast cancer treatment, the importance of de-escalation therapy to reduce harm during the treatment of elderly patients has attracted attention in recent years. Certain patient populations are expected to have a superior response to anti-HER2 drugs, particularly those with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. In this report, we describe our experience of dramatic anti-HER2 drug response in a patient who achieved pathological complete response (pCR) with a single dose of trastuzumab.
An 88-year-old woman presented with a 2-cm palpable mass in the left breast. Vacuum-assisted breast biopsy, ultrasonography, and positron emission tomography-computed tomography revealed estrogen receptor-negative and HER2-positive, T1N0M0, stage I breast cancer. Mastectomy was scheduled within 2 months of the initial visit; however, the patient was anxious about the length of the waiting period and requested medication in the interim. Therefore, prior to surgery, one cycle of trastuzumab monotherapy was administered at the discretion of the attending physician. Postoperative pathology showed no remnant of invasive carcinoma and pCR with only a 0.2-mm ductal carcinoma in situ remnant. The patient refused further medication after surgery because of severe diarrhea after trastuzumab administration. Postoperative treatment was limited to follow-up, and no recurrence was observed at 1 year and 6 months postoperatively.
This case suggests that trastuzumab monotherapy may be effective in certain patients with HER2-positive breast cancer. In the future, identifying patients who are more likely to respond to trastuzumab, as in this case, will allow for more options regarding de-escalation therapy without chemotherapy, particularly in elderly patients who are concerned about the side effects of chemotherapy.
随着乳腺癌治疗的进展，近年来，降阶梯治疗在减少老年患者治疗期间伤害方面的重要性已引起关注。某些患者群体预计对抗HER2药物反应更佳，尤其是那些患有人类表皮生长因子受体2（HER2）阳性乳腺癌的患者。在本报告中，我们描述了一名患者仅用一剂曲妥珠单抗就实现了病理完全缓解（pCR），对抗HER2药物产生显著反应的经验。
一名88岁女性，左乳可触及一个2厘米的肿块。真空辅助乳腺活检、超声检查和正电子发射断层扫描-计算机断层扫描显示雌激素受体阴性、HER2阳性、T1N0M0、I期乳腺癌。计划在初次就诊后2个月内进行乳房切除术；然而，患者对等待期的时长感到焦虑，并要求在此期间用药。因此，在手术前，主治医生酌情给予了一个周期的曲妥珠单抗单药治疗。术后病理显示无浸润性癌残留，仅残留0.2毫米的原位导管癌，达到pCR。由于使用曲妥珠单抗后出现严重腹泻，患者术后拒绝进一步用药。术后治疗仅限于随访，术后1年零6个月未观察到复发。
本病例表明，曲妥珠单抗单药治疗可能对某些HER2阳性乳腺癌患者有效。未来，识别出像本病例中这样更可能对曲妥珠单抗产生反应的患者，将为无化疗的降阶梯治疗提供更多选择，特别是对于担心化疗副作用的老年患者。
