Departments of 1Oncology and 2Radiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
Received 24 January 2001; revised 26 June 2001; accepted 24 July 2001.
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Abstract |
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Key words: breast cancer, cavitation, lung metastases
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Introduction |
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Case history |
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The patient received adjuvant chemotherapy (5-fluoro-uracil, doxorubicin, cyclophosphamide, given on day 1 of each of six 21-day cycles), and radiation therapy to the axilla and supraclavicular area. The patient was well until July 1999 when multiple lung lesions were observed on routine chest radiography. Computed tomography (CT) of the chest demonstrated multiple lesions compatible with lung meta-stases (Figure 1A). Metastatic breast cancer was confirmed by open biopsy. Docetaxel (Taxotere®; Aventis, Pharma, UK) 100 mg/m2 every 21 days was given for 2 months (three cycles). It was stopped due to progressive disease. Treatment was changed to weekly paclitaxel (Taxol®; Bristol-Myers Squibb, Princeton, NJ, USA) 100 mg/m2 ¥ 1 h and the humanized anti-Her-2 antibody trastuzumab (Herceptin®; Genentech Inc., San Francisco, CA, USA) 4 mg/kg loading, then 2 mg/kg i.v. q week. Two months later, CT showed disappearance of most of the nodular lesions with the appearance of multiple cavity lesions (Figure 1B). Treatment was continued for 8 months until brain metastases appeared.
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Discussion |
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Mermershtain et al. [8] reported on an unusual cystic transformation of solid metastatic lesions in patients with metastatic malignant melanoma after sequential chemo-immunotherapy. In the described melanoma patients, meta-stases in the liver, retroperitoneum, axilla and spleen underwent dramatic changes, as seen on CT, consistent with massive cystic necrosis. Aspirates from cysts contained only bloody debris, with no malignant cells.
The current case is different because a pulmonary cavity is not filled with fluid or necrotic debris and we cannot prove the disappearance of malignant cells.
The interesting point is the response obtained under Taxol® and Herceptin® therapy in a patient who was Taxotere® refractory. In a Cancerlit search we could find only one case report, from Japan [9], of docetaxel-resistant lung metastasis from breast cancer responsive to paclitaxel therapy. Sequential chemobiotherapy has additive or synergistic antitumor effects. With the development of the humanized anti-Her-2 antibody (trastuzumab), biological therapy of breast cancer has become a reality. Herceptin® is the first humanized monoclonal antibody for patients with metastatic breast cancer who overexpress Her-2/neu membrane staining. Phase II and III clinical trials demonstrated clinical efficacy and safety of Herceptin® [10, 11]. In the present case we observed a near complete response with cavitation of solid metastatic lesions. It is hard to believe that these changes would have occurred without treatment; we cannot, however, prove that it is a result of the treatment, which may have been due to Taxol®, Herceptin® or both, because the cavitation began before treatment (Figure 1A).
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Footnotes |
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References |
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