A case of synchronous bilateral breast cancer with different pathological responses to neoadjuvant chemotherapy with different biological character

Mitsuhiro Hayashi,Hirotaka Iwase,Noboru Takata,Yutaka Yamamoto

doi:10.1186/2193-1801-2-272

Abstract

We report a case of synchronous locally advanced bilateral breast cancer with different pathological responses to neoadjuvant chemotherapy with different biological character. The patient had presented bilateral breast cancer: the left breast cancer was hormone receptor negative, human epidermal growth factor receptor-2 (HER2) positive, and classified as T4bN1M0, stage IIIb, while the right was hormone receptor positive, HER2-negative, and classified as T4bN0M0, stage IIIb. We administered four cycles of anthracycline-based therapy followed by 12 weekly cycles of taxane with trastuzumab for neoadjuvant chemotherapy. We had achieved a significant left tumor reduction after each chemotherapy, but not right tumor. Bilateral modified radical mastectomies with axillary lymph-node dissection were performed. The therapeutic effect in the left was determined as a pathological complete response, in contrast to the right side. She has no recurrence for more than five years, though she had advanced cancer with oncologic emergency. This case could be an informative experience to understand the relation of tumor biology and response to systemic therapy.

Highlights

The escalation of targeting therapy in breast cancer is supported by a research of tumor biology
The therapeutic background of each breast cancer were similar condition except for the tumor characteristics, we reported this meaningful or educational case to understand the relation of tumor biology and sensitivity of neoadjuvant chemotherapy (NAC)
We had planned NAC targeting to the left breast cancer which seemed more progressive disease, we administered FEC followed by wPac + T and as expected, those mass showed different mass reduction responses

Summary

Introduction

The escalation of targeting therapy in breast cancer is supported by a research of tumor biology. Estrogen receptor (ER), Progesterone receptor (PgR), and human epidermal growth factor receptor-2 (HER2) are establish as strong predictive factors to induct each molecular targeting therapy, such as endocrine therapy and anti-HER2 therapy (Iwase 2008) (Hudis 2007) These biological markers have been investigated to be concerned with the effects of cytotoxic chemotherapy. The clinical research of NAC is mostly based on clinical trials which consist of a variety of patient groups, and larger patient samples of well annotated are demanded to exclude each individual host characteristics In this time, we experienced a valuable treatment case, which could reveal a correlation between tumor biology and response to NAC without host characteristic. At the start of treatment, several lymph nodes in the left axilla were clearly swelling indicating metastasis (upper) After neoadjuvant chemotherapy those were not swelling (lower)

Nuclear Grade

Discussion