Management of HER2-Positive Breast Cancer for a Young Patient with Visceral Crisis—The Adjuvant Role of Lifestyle Changes

Abstract

The safety profile and effectiveness of existing anti-HER2-targeted therapies have not been evaluated in patients with breast cancer and visceral crisis. We report the case of a 26-year-old woman who was diagnosed with advanced HER2-positive breast cancer and initially treated with curative intent therapy in a neoadjuvant setting, using Trastuzumab and Pertuzumab in combination with Docetaxel; her cancer recurred two years later, with liver metastases and pulmonary lymphangitic carcinomatosis, causing visceral crisis. Furthermore, the patient’s clinical status worsened when she developed respiratory failure, hepatomegaly and a severe hepatocytolysis. Since the patient was free of disease more than six months, we started with Paclitaxel half dose because of the hepatic dysfunction, and we gradually reintroduced Trastuzumab and then Pertuzumab. In the meantime, the patient changed her lifestyle by increasing her consumption of fresh fruits and vegetables and fiber and reducing her intake of processed meat, dairy and sugar. As a result, the patient showed a significant improvement in her respiratory symptoms and liver tests in less than two months. Imaging reevaluation showed partial remission of liver metastases and pulmonary lymphangitic carcinomatosis. She underwent seven months of dual anti-HER2 blockade before relapsing cerebrally. Our results suggest that the sequential combination therapy with Trastuzumab, Pertuzumab and Paclitaxel presented in this study, associated with a healthy lifestyle, may be a good management for recurrent HER2-positive breast cancer with pulmonary visceral crisis and severe liver dysfunction.

Efficacy of first‐line dual oral pyrotinib plus capetabine therapy in HER2‐positive metastatic breast cancer: A real‐world retrospective study

“…Currently, only case reports with weak levels of evidence have shown promising anti‐tumor effects for patients with visceral crises when combining HER2‐targeted therapy with chemotherapy. 27 Therefore, the combination of pyrotinib‐based therapies (including PyroC) needs to be further validated in dealing with a visceral crisis. Furthermore, we found that the efficacy of pyrotinib is not affected by the use of HER2‐targeted therapy as front‐line treatment including both neoadjuvant and adjuvant settings.…”

“…Patients with visceral crisis require rapidly effective treatment to address severe organ dysfunction, 26 but adequate assessment of randomized trials on these existing anti‐HER2‐targeted therapies' effectiveness has not yet been conducted. Currently, only case reports with weak levels of evidence have shown promising anti‐tumor effects for patients with visceral crises when combining HER2‐targeted therapy with chemotherapy 27 . Therefore, the combination of pyrotinib‐based therapies (including PyroC) needs to be further validated in dealing with a visceral crisis.…”

Clinical Review on the Management of Breast Cancer Visceral Crisis

“…Two case reports demonstrated the efficacy of tailored management for patients with lymphangitic carcinomatosis treated with eribulin (HR+/HER2- ABC) or paclitaxel, trastuzumab and pertuzumab in personalised doses (HER2+ ABC), achieving both positive symptom control and a partial radiological response [ 13 , 14 ].…”