Authors: Taushanova-Hadzhieva Margarita, Raycheva Janet, Dzhadzheva Daniela, Atanassova Mariana.
In 2006 a 35-year old female patient was having a tumour mass (4,5cm) on the right breast. It was biopsied and histologically verified invasive ductal carcinoma – ER 0%; PR 0%; HER2 (0) – TNBC, cT3 Nx M0. She underwent 4 cycles neoadjuvant therapy with anthracyclines (FEC). Afterwards it was perfomed a right sided mastectomy with axillary lymph node dissection (12 lymph nodes without metastases) and she was staged as pT2 N0 M0, G2 invasive ductal carcinoma, ER 0%; PR 0%; HER2 (0); Ki67 = 15%. She has no family history for cancer; BRCA1/2 negative. The patient had 4 cycles with Docetaxel (75mg/m2) in adjuvant aspect and 50 Gy radiotherapy on the thoracic wall and the axill.
She was on a dynamic control for 7 years (between 2007 – 2015). Computer tomography (CT), bone scintigraphy and abdominal ultrasound were regularly made.
In 2015 it was observed a slight progression of the tumor marker up to 35 U/ml. A bone scintigraphy was performed, that showed bone metastases, and treatment was started with Denosumab 120mg s.c.
In November 2016 a PET/CT (positron emission tomography) was made and it was detected a new progression of the disease with three new mediastinal lymph nodes. She started systemic treatment with Docetaxel (75mg/m2) for six cycles together with Denosumab 120mg. A control CT showed stable disease. She continued with Capecitabine 1250 mg/m2+ Denosumab. This treatment lasted four months due to poor tolerance and toxicity. Palliative radiotherapy for mediastinum was made.
On 12.02.2018 another PET/CT showed progression of the mediastinal lymph nodes. The patient received treatment with Eribulin 1.23mg/m2 (day 1,8) for five months.
In September another progression was detected with more than 20% enlargement of the observed mediastinal lymph nodes. A biopsy was performed, which proved the same histology of the tumor – invasive ductal carcinoma ER 0%; PR 0%; HER2 (0); Androgen Receptor positive (2+3=5/8). The patient agreed on treatment with Bicalutamide 50mg p.o. daily + Denosumab 120mg s.c. monthly. The treatment with antiandrogen started in December 2018 and
continued until 08.2019 when another progression of the mediastinal lymph nodes was detected.
The treatment with Bicalutamide was well tolerated without any adverse events or any toxicity during the whole period of nine months.
View/Download pdf