Treatment of diffuse cutaneous metastases from breast cancer

Abstract

Cutaneous metastases, while rare, are most commonly from breast cancer, commonly after several lines of systemic therapy malignancy. 1,2 Skin metastases can cause pain, bleeding, and infection, leading to challenges in regard to treatment and quality of life. 1,2 Multiple strategies exist for progressive cutaneous metastases including changing systemic therapy, topical or intralesional therapy, electrochemotherapy, photodynamic therapy, and radiation therapy (RT). 1-4 With respect to RT, the extent of disease can be challenging to treat (bilateral chest walls anteriorly and posteriorly, axilla, arms, and head and neck). Conventional RT techniques, including electron fields and 3-dimension conformal radiation therapy (3D-CRT), are limited due to the complexity of setup and ability to spare normal tissues, particularly in cases of re-irradiation. 5 Intensity-modulated radiation therapy (IMRT) allows for organ sparing over large volumes;

Efficacy of Electrochemotherapy in Breast Cancer Patients of Different Receptor Status: The INSPECT Experience

“…ECT was delivered based on European Standard Operating Procedures for Electrochemotherapy (ESOPE) updated guidelines [9]. Bleomycin was administrated in one of the following ways: intratumorally at a dose of 1000 IU/cm 3 for tumor volume < 0.5 cm 3 , 500 IU/cm 3 for tumor volume between 0.5 and 1 cm 3 , 250 IU/cm 3 for tumor volume > 1 cm 3 , or intravenous at 15,000 IU m 2 body surface. Electroporation was achieved using the Cliniporator (IGEA, Carpi, Italy), delivering 8 pulses of 100 ms at 1 kV/cm.…”

“…Surgery could be a first option in single small metastasis, while treatment of larger or multiple lesions spreading into a larger area could be challenging. Systemic therapies could be proposed according to tumor subtype (histology, immunohistochemistry, hormonal status, receptor status), while radiotherapy could be chosen if not previously delivered [ 3 , 4 ].…”

Case Report: Significant Efficacy of Pyrotinib in the Treatment of Extensive Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Cutaneous Metastases: A Report of Five Cases

“…Breast cancer (BC) is the most common primary tumor in cutaneous metastatic malignancies, and the HER2-positive subtype was more common than other subtypes in cutaneous metastasis of BC (8.3%) (1)(2)(3)(4). Tumor tissue necrosis caused by the conventional treatment of cutaneous metastases of BC often causes temporary aggravation of cutaneous symptoms, which leads to increased subjective pain and misjudgment of the treatment effect (5). For HER2-positive BC patients, the use of anti-HER2 monoclonal antibody (mAb) is the standard treatment.…”