Jiang Heng, Cartwright Sara, Wagner David G, Krishnamurthy Jairam, Santamaria-Barria Juan A
Department of Medicine, Westchester Medical Center, Valhalla, USA.
Department of Surgery, University of Nebraska Medical Center, Omaha, USA.
Cureus. 2024 Jun 13;16(6):e62338. doi: 10.7759/cureus.62338. eCollection 2024 Jun.
Neoadjuvant chemoimmunotherapy with pembrolizumab now defines the standard of care for early high-risk triple-negative breast cancer (TNBC). However, the role of pembrolizumab in neoadjuvant therapy (NAT) for estrogen receptor-positive (ER+) breast cancer remains uncertain. A 39-year-old G2P2 female discovered a palpable mass in the right breast while breastfeeding her 7-month-old child, leading to the diagnosis of a high-grade ER+ (80% moderate staining), human epidermal growth factor receptor 2-negative (ErbB2-) invasive ductal carcinoma with axillary nodal involvement. Gene expression profiling with the MammaPrint 70-gene signature and BluePrint 80-gene signature revealed a tumor with high-risk, basal-type biology. The multidisciplinary breast cancer team recommended NAT with pembrolizumab, carboplatin, paclitaxel, doxorubicin, and cyclophosphamide. Within six weeks, the patient exhibited a remarkable response, with no palpable mass or lymph node, and post-treatment examinations confirmed a complete clinical and radiologic response. The patient underwent lumpectomy and sentinel lymph node biopsy, revealing a pathological complete response with minimal ductal carcinoma in situ and negative axillary nodes. Adjuvant radiation therapy was administered, and the patient completed adjuvant pembrolizumab, currently showing no evidence of recurrence. This case underscores the potential benefits of neoadjuvant chemoimmunotherapy for patients with ER+ErbB2- high-risk, basal-type breast cancer. The use of immunotherapy in patients with pregnancy-associated breast cancer remains to be further investigated.
帕博利珠单抗新辅助化疗免疫疗法现已成为早期高危三阴性乳腺癌（TNBC）的标准治疗方案。然而，帕博利珠单抗在雌激素受体阳性（ER+）乳腺癌新辅助治疗（NAT）中的作用仍不明确。一名39岁、孕2产2的女性在给7个月大的孩子喂奶时发现右乳有可触及肿块，诊断为高级别ER+（中度染色80%）、人表皮生长因子受体2阴性（ErbB2-）浸润性导管癌伴腋窝淋巴结受累。采用MammaPrint 70基因检测和BluePrint 80基因检测进行基因表达谱分析，结果显示肿瘤具有高危、基底样生物学特征。多学科乳腺癌团队建议采用帕博利珠单抗、卡铂、紫杉醇、多柔比星和环磷酰胺进行新辅助治疗。六周内，患者出现显著反应，未触及肿块或淋巴结，治疗后检查证实临床和影像学完全缓解。患者接受了肿块切除术和前哨淋巴结活检，结果显示病理完全缓解，原位导管癌极少，腋窝淋巴结阴性。给予辅助放疗，患者完成辅助帕博利珠单抗治疗，目前未发现复发迹象。该病例强调了新辅助化疗免疫疗法对ER+ErbB2-高危、基底样乳腺癌患者的潜在益处。免疫疗法在妊娠相关乳腺癌患者中的应用仍有待进一步研究。
