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LETTER TO THE EDITOR
Year : 2018  |  Volume : 14  |  Issue : 3  |  Page : 722-723

Hepatic metastasectomy and paclitaxel provide long-term survival for a young woman with recurrent triple-negative metastatic breast cancer: 16 years follow-up


Division of Medical Oncology, Cancer Center of Kuang Tien General Hospital, Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan

Date of Web Publication12-Jun-2018

Correspondence Address:
Dr. Victor C Kok
117 Shatien Road, Shalu 43303, Taichung
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.179087

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How to cite this article:
Kok VC. Hepatic metastasectomy and paclitaxel provide long-term survival for a young woman with recurrent triple-negative metastatic breast cancer: 16 years follow-up. J Can Res Ther 2018;14:722-3

How to cite this URL:
Kok VC. Hepatic metastasectomy and paclitaxel provide long-term survival for a young woman with recurrent triple-negative metastatic breast cancer: 16 years follow-up. J Can Res Ther [serial online] 2018 [cited 2018 Nov 19];14:722-3. Available from: http://www.cancerjournal.net/text.asp?2018/14/3/722/179087



Sir,

Surgery for breast cancer (BC) oligometastases with curative intent established through a multidisciplinary approach has recently received deserved attention at the prominent professional oncological conference.[1] For the past decade, breast oncologists have been bothered by whether the concept of oligometastases was a hypothesis or a reality.[2],[3] Triple-negative BC (TNBC) portends a worse prognosis, particularly in women under the age of 40. Hepatic metastasis from BC carries a very dismal prognosis and requires multidisciplinary seamless implementation of an antineoplastic strategy to overcome the disease. Hepatectomy is often discouraged as an upfront treatment because of systemic disease consideration.

We report here a case of a young woman who survived our delivery of personalized multimodal treatment. On April 9, 1998, a 38-year-old woman underwent a right modified radical mastectomy for her newly discovered right BC. The pathological stage was determined as pT4b pN2a (4+/9) M0 Stage IIIB. The tumor was estrogen receptor (ER)-positive, progesterone receptor (PR)-negative, and HER2/neu nonoverexpressed. Adjuvant chemotherapy with a combination of 5-fluorouracil at 500 mg/m 2, epirubicin 90 mg/m 2, and cyclophosphamide 500 mg/m 2 for six cycles was given, followed by adjuvant radiotherapy. However, distant metastasis to the liver was discovered fairly soon in June 1999. The patient initially hesitated but later accepted definitive treatment with curative intent. She underwent S2, S3, S4 three segmentectomy, and cholecystectomy on September 2, 1999. The tumor this time was ER-negative, PR-negative, and HER2-negative. After the complete tumor resection, the patient was given six cycles of paclitaxel at 175 mg per meter squared every 3 weeks for six cycles, with the last cycle given on January 10, 2000. She has remained disease-free since then.

A recently reported cohort of 414 patients with TNBC disclosed that one out of four patients will experience a locoregional and/or distant relapse, with 60% of them having an isolated distant relapse ultimately accounting for up to 75% of BC-specific mortality for those who experienced a distant relapse.[4] The success in this case lies in the ability to achieve R-0 resection (residual-zero denoting no clinical evidence of microscopic residual tumor), good dose intensity of postresection chemotherapy, and the choice of paclitaxel, which may be the right drug to be able to eradicate micrometastases most likely existed.

Adjuvant chemotherapy following an R-0 resection should be a part of the curative treatment planning for a patient with distant visceral organ metastases. A taxane in previously unexposed patients is a good choice. The q3w conventional paclitaxel schedule administered in this case is rarely used. The preferred schedules for paclitaxel are weekly administration.[5] An eagerly awaited answer on whether nab-paclitaxel (a solvent-free formulation of paclitaxel in albumin-bound nanoparticles) or ixabepilone (a novel semisynthetic analog of epothilone B) is better than conventional paclitaxel was just provided in a randomized Phase III trial carried out by both the CALGB and the NCCTG.[5] In patients with chemonaive advanced BC, ixabepilone was inferior to paclitaxel, and nab-paclitaxel was not superior with a trend toward inferiority and more toxicities. Paclitaxel once per week remains the preferred palliative chemotherapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Salama JK, Chmura SJ. Surgery or Ablative Radiotherapy for Breast Cancer Oligometastases. American Society of Clinical Oncology Educational Book. ASCO American Society of Clinical Oncology Meeting, Vol. 35; 2015. p. e8-15.  Back to cited text no. 1
    
2.
Tait CR, Waterworth A, Loncaster J, Horgan K, Dodwell D. The oligometastatic state in breast cancer: Hypothesis or reality. Breast 2005;14:87-93.  Back to cited text no. 2
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3.
Iwata H. Future treatment strategies for metastatic breast cancer: Curable or incurable? Breast Cancer 2012;19:200-5.  Back to cited text no. 3
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4.
Steward L, Conant L, Gao F, Margenthaler JA. Predictive factors and patterns of recurrence in patients with triple negative breast cancer. Ann Surg Oncol 2014;21:2165-71.  Back to cited text no. 4
[PUBMED]    
5.
Rugo HS, Barry WT, Moreno-Aspitia A, Lyss AP, Cirrincione C, Leung E, et al. Randomized phase III trial of paclitaxel once per week compared with nanoparticle albumin-bound nab-paclitaxel once per week or ixabepilone with bevacizumab as first-line chemotherapy for locally recurrent or metastatic breast cancer: CALGB 40502/NCCTG N063H (Alliance). J Clin Oncol 2015;33:2361-9.  Back to cited text no. 5
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