Pangarsa Eko Adhi, Astuti Putri Dwi, Rizky Daniel, Tandarto Kevin, Setiawan Budi, Winarno Andreas Agung, Santosa Damai, Suharti Catharina
Hematology Medical Oncology Division, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital Semarang, Semarang, Indonesia.
. Elisabeth Hospital Semarang, Semarang, Indonesia.
J Med Case Rep. 2024 Dec 5;18(1):591. doi: 10.1186/s13256-024-04922-4.
Metastatic breast cancer especially in disseminated carcinomatosis of bone marrow (DCBM) poses a life-threatening risk, often requiring systemic chemotherapy. This situation lacks a cure, emphasizing symptom relief and quality of life. The documented occurrence of DCBM is merely 0.17% in metastatic breast cancer and ranges from 0.6 to 1.7% in solid tumors. Until now, there is no official medical guideline for treating patients with luminal breast cancer (LBC) who have DCBM. This case report highlights LBC patient with DCBM, treated at diagnosis with first-line therapy combining endocrine therapy (ET) and a CDK4/6 inhibitor.
A 36-year-old premenopausal female of Javanese ethnicity with advanced de novo luminal breast cancer diagnosed in 2020. The immunohistochemistry showed estrogen receptor (ER)+ (90%), progesterone receptor (PR)+ (20%), human epidermal growth factor receptor 2 (HER-2) negative, and a high Ki-67 staining result at 60%. The patient had visceral crisis, which involved bone marrow infiltration and liver metastasis with preserved liver function. After intolerance of side effects from first line treatment with tamoxifen, the treatment plan was adjusted to letrozole, ribociclib, and leuprorelin injection. After completing the sixth cycle of treatment, blood parameters in the laboratory were found to have returned to normal. The patient's response to this regimen was remarkable, with significant alleviation of symptoms and improvement in quality of life observed.
Notably, the combined approach of ET and CDK4/6 inhibitor represents a novel intervention in managing DCBM in patients with LBC.
转移性乳腺癌，尤其是骨髓播散性癌（DCBM），会带来危及生命的风险，通常需要进行全身化疗。这种情况无法治愈，因此重点在于缓解症状和提高生活质量。在转移性乳腺癌中，DCBM的记录发生率仅为0.17%，在实体瘤中为0.6%至1.7%。到目前为止，对于患有DCBM的管腔型乳腺癌（LBC）患者，尚无官方治疗指南。本病例报告重点介绍了一名患有DCBM的LBC患者，在诊断时接受了内分泌治疗（ET）和CDK4/6抑制剂联合的一线治疗。
一名36岁的绝经前爪哇族女性，于2020年被诊断为晚期原发性管腔型乳腺癌。免疫组化显示雌激素受体（ER）阳性（90%），孕激素受体（PR）阳性（20%），人表皮生长因子受体2（HER-2）阴性，Ki-67染色结果高，为60%。患者出现内脏危象，累及骨髓浸润和肝转移，但肝功能保留。在对他莫昔芬一线治疗的副作用不耐受后，治疗方案调整为来曲唑、瑞博西尼和亮丙瑞林注射。完成第六周期治疗后，实验室血液参数恢复正常。患者对该方案的反应显著，症状明显缓解，生活质量得到改善。
值得注意的是，ET和CDK4/6抑制剂联合应用是治疗LBC患者DCBM的一种新干预措施。
