Palbociclib + endocrine therapy for hormone-positive HER2-negative metastatic breast cancer: 5 cases
- 3 years ago
Mol Clin Oncol. 2020 May; 12(5): 456–460. doi: 10.3892/mco.2020.2016
Case 1
The first patient was a 56-year-old woman without relevant comorbidities, first diagnosed in July 2015 with invasive ductal carcinoma (IDC) of the right breast, pT3 pN1, intermediate-grade (G2), estrogen receptor (ER)- and progesterone receptor (PR)+ (~90% expression for both), Ki67 proliferative index 30% and HER2-. The patient was initially treated with right radical mastectomy and ipsilateral axillary lymphadenectomy. Preoperative staging was negative for metastatic disease. Since the patient had a persistent cough that started a few months before the BC diagnosis, a whole-body computed tomography (CT) scan was performed, which revealed several liver and lung nodules. A biopsy of one of the liver lesions revealed HR+/HER2- IDC, which was consistent with the primary tumor. Weekly paclitaxel at 80 mg/m2 was started as first-line therapy for MBC in September 2015. In January 2016 paclitaxel was discontinued due to a central venous access infection and grade 3 peripheral neuropathy. Letrozole was then started as maintenance ET at the standard dose of 2.5 mg/day per os. Tumor progression was detected after ~10 months of AI (October 2016); thus, letrozole was discontinued and fulvestrant 500 mg i.m. was administered every 4 weeks after an initial 2-week induction (henceforth defined as fulvestrant SD). In February 2017, due to progression of the liver disease, palbociclib was added to fulvestrant at a dose of 125 mg daily for 21 consecutive days followed by 7 days off therapy for a cycle of 28 days (standard schedule). Overall, the treatment was well-tolerated, except for persistent G3 neutropenia after the third cycle of therapy, after which time the palbociclib dose was decreased from 125 to 100 mg daily. In February 2018, after recovery from a G4 non-febrile neutropenia, palbociclib was further reduced to 75 mg. The disease remained stable according to RECIST throughout the whole treatment, until disease progression. In May 2018, due to the increase of the lung and liver lesions, palbociclib and fulvestrant were suspended and chemotherapy was started. The patient is still undergoing treatment.
Case 2
A 75-year-old woman, also suffering from hypertension and cataract, was initially diagnosed with early BC in 1992. At the time of initial diagnosis, the patient was 50 years old and was treated with right breast quadrantectomy and ipsilateral axillary lymph node dissection for a pT2 pN0 ER+ and PR+ with unknown HER2 status invasive lobular carcinoma (ILC). The patient also received standard adjuvant radiotherapy after surgery and adjuvant tamoxifen at the standard dose of 20 mg daily per os. In March 2010, a right breast nodule was surgically resected. The pathology report described the lesion as a G2, ER+ and PR+ (90 and 80% expression, respectively), Ki67 50% and HER2+ (immunohistochemical score 3+) ILC. As no other lesions were present on a postoperative CT scan, the pat
Case 1
The first patient was a 56-year-old woman without relevant comorbidities, first diagnosed in July 2015 with invasive ductal carcinoma (IDC) of the right breast, pT3 pN1, intermediate-grade (G2), estrogen receptor (ER)- and progesterone receptor (PR)+ (~90% expression for both), Ki67 proliferative index 30% and HER2-. The patient was initially treated with right radical mastectomy and ipsilateral axillary lymphadenectomy. Preoperative staging was negative for metastatic disease. Since the patient had a persistent cough that started a few months before the BC diagnosis, a whole-body computed tomography (CT) scan was performed, which revealed several liver and lung nodules. A biopsy of one of the liver lesions revealed HR+/HER2- IDC, which was consistent with the primary tumor. Weekly paclitaxel at 80 mg/m2 was started as first-line therapy for MBC in September 2015. In January 2016 paclitaxel was discontinued due to a central venous access infection and grade 3 peripheral neuropathy. Letrozole was then started as maintenance ET at the standard dose of 2.5 mg/day per os. Tumor progression was detected after ~10 months of AI (October 2016); thus, letrozole was discontinued and fulvestrant 500 mg i.m. was administered every 4 weeks after an initial 2-week induction (henceforth defined as fulvestrant SD). In February 2017, due to progression of the liver disease, palbociclib was added to fulvestrant at a dose of 125 mg daily for 21 consecutive days followed by 7 days off therapy for a cycle of 28 days (standard schedule). Overall, the treatment was well-tolerated, except for persistent G3 neutropenia after the third cycle of therapy, after which time the palbociclib dose was decreased from 125 to 100 mg daily. In February 2018, after recovery from a G4 non-febrile neutropenia, palbociclib was further reduced to 75 mg. The disease remained stable according to RECIST throughout the whole treatment, until disease progression. In May 2018, due to the increase of the lung and liver lesions, palbociclib and fulvestrant were suspended and chemotherapy was started. The patient is still undergoing treatment.
Case 2
A 75-year-old woman, also suffering from hypertension and cataract, was initially diagnosed with early BC in 1992. At the time of initial diagnosis, the patient was 50 years old and was treated with right breast quadrantectomy and ipsilateral axillary lymph node dissection for a pT2 pN0 ER+ and PR+ with unknown HER2 status invasive lobular carcinoma (ILC). The patient also received standard adjuvant radiotherapy after surgery and adjuvant tamoxifen at the standard dose of 20 mg daily per os. In March 2010, a right breast nodule was surgically resected. The pathology report described the lesion as a G2, ER+ and PR+ (90 and 80% expression, respectively), Ki67 50% and HER2+ (immunohistochemical score 3+) ILC. As no other lesions were present on a postoperative CT scan, the pat