Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer

Nieder, Carsten; Mannsåker, Bård; Haukland, Ellinor

doi:10.7759/cureus.1412

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Therefore, refractory MBC generally harbors a more dismal prognosis than dnMBC (27,(32)(33)(34)(35)(36). Following active treatment, some patients with dnMBC can obtain a long survival time (37).…”

Section: Heterogeneity Of Dnmbcmentioning

confidence: 99%

Aggressive local therapy for de novo metastatic breast cancer: Challenges and updates (Review)

Liu

Lü

2023

Oncol Rep

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Systemic therapy has been viewed as the mainstay for de novo metastatic breast cancer (dnMBC). However, as dnMBC is highly heterogeneous both biologically and clinically, and with ever-improving systemic strategies, it has been implied that the local therapy of the primary tumor (PT) may be beneficial for certain patients with dnMBC. However, the results from retrospective studies have been questioned due to their selection bias and retrospective nature. To the best of our knowledge, there are two published randomized clinical trials addressing this issue with conflicting conclusions: i) TATA study from India indicated no overall survival (OS) superiority with early local radiotherapy (LRT); and ii) MF07-01 indicated a 5-year OS rate improvement of 17% with upfront LRT. The updated results of a randomized phase III ECOG-ACRIN E2108 trial released in the 2020 American Society of Clinical Oncology (ASCO) meeting reported a negative survival effect of early LRT treatment in patients with dnMBC responding to initial systemic treatment, despite LRT significantly reducing the locoregional failure. Thus, a number of issues, such as the exact value of LRT, the optimal means of LRT (surgery and/or RT to the PT), the ideal timing of LRT and the population most likely to benefit from LRT, warrant further investigation. Herein, the related studies focusing on these aspects were comprehensively reviewed and a decision algorithm was proposed to select suitable patients with dnMBC for reasonable LRT. Generally, upfront systemic therapy is recommended. For good respondents and a subgroup of favorable profiles (young age, good general condition, low tumor burden, hormone receptor-positive and so on), radical LRT including PT surgery followed by RT and the resection of distant metastases is recommended. LRT should also be administered if the PT is still symptomatic. LRT may benefit patients with dnMBC due to the following reasons: Control of the PT decreases tumor burden, eliminates the source of dissemination, enhances the sensitivity to therapy and exerts positive immunomodulation. Therefore, the treatment paradigm for dnMBC may change from ‘palliative LRT’ into ‘curative LRT’ in a highly selected entity with careful evaluation.

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Section: Heterogeneity Of Dnmbcmentioning

confidence: 99%

Aggressive local therapy for de novo metastatic breast cancer: Challenges and updates (Review)

Liu

Lü

2023

Oncol Rep

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“…A clear delineation is described with improved quality of life measures despite the terminality of the primary cancer. Concurrently, 14 studies noted statistically significant survival rates in individuals who underwent palliative mastectomy [11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Of these aggregates, three studies noted no difference in patient survival outcome and concluded with conflicting data [25][26][27].…”

Section: Literature Reviewmentioning

confidence: 99%

Palliative Modified Radical Mastectomy to Improve Quality of Life by Decreasing Disease Burden: A Case Report

Rostami¹,

Ladd²,

Stewart³

et al. 2021

Asp Biomed Clin Case Rep

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In cases of advanced pathology, palliative medicine is able to confer a great deal of relief to the patient. In the same light, surgical intervention is able to provide increased quality of life in cases of extensive disease burden, providing palliation where curative measures cannot be achieved. In the case study therein, a patient presents with metastatic breast cancer with a localized fungating mass contributing to severe local and systemic symptomatology. In this setting, invasive management of her disease allowed for clinical improvement of the patient when medical management alone was not sufficient. The patient quickly demonstrated recovery of her symptoms in the post-operative phase when the local disease was resected. The utilization of invasive measures, as seen in this case, further proves the importance of multidisciplinary palliative care where surgical measures are included in patient care.

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Exceptional Responses to Standard Therapy in a Patient with Metastatic HER2-Positive Breast Cancer

Cited by 2 publications

References 7 publications

Aggressive local therapy for de novo metastatic breast cancer: Challenges and updates (Review)

Aggressive local therapy for de novo metastatic breast cancer: Challenges and updates (Review)

Palliative Modified Radical Mastectomy to Improve Quality of Life by Decreasing Disease Burden: A Case Report

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