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A CASE REPORT OF METASTATIC BREAST CANCER MANAGED WITH HORMONE THERAPY

Ahmed Ahmed, Nalyan Aliadinova, Borislav Todorov, Figen Mustafa, Margarita Trifonova

Abstract

Introduction: Breast cancer is the most frequently diagnosed life-threatening cancer in women worldwide and the leading cause of cancer death among women. The different forms of breast cancer require specific treatment plans. In the presented case endocrine therapy has a salutary effect on the patient with expressed hormone receptors.

Materials and Methods: A 55-year-old postmenstrual woman  was diagnosed with highly differentiated multifocal invasive ductal carcinoma including perineural invasion and metastases in the lymph nodes, pT2N2aM0, G1 in 2010.The premenopausal patient then had undergone a radical surgical intervention-quadrantectomy and simple mastectomy of the left mammary gland. Adjuvant chemotherapy and hormone therapy with goserelin and tamoxifen consequently were necessary to block the actions of estrogen. In 2012, during a control checkup, liver metastases were discovered and therefore the patient was given first-line therapy with bevacizumab and capecitabine. Due to further growth of the liver metastases, a second-line therapy with docetaxel and carboplatin was appointed. As the development of the metastases could not be managed yet, an ultimate third-line antiestrogene and targeted therapy with everolimus and exemestane was required. The efficiency of the treatment, proceeding 4 years already, establishes a steady state disease on PET/CT.

Result: Since the patient’s type of cancer was evaluated as estrogen receptor-positive, progesterone-positive and HER2-negative, with an immunohistochemical staining score of 1+, the most appropriate and up-to-date administration is the combination of the mTOR inhibitor-everolimus with aromatase inhibitor-exemestane. Blocking both pathways not only ameliorated the antitumor activity but also reversed endocrine therapy resistance to mTOR signaling.

Conclusions: According to recent researches this composite therapy results in an improved clinical outcome as both life expectancy and quality of life are enhanced.


Keywords

breast cancer, hormone therapy


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