Life-threatening metastasis was suppressed by trastuzumab containing regimen in a patient with Her2-negative breast cancer

Abstract

A 49-year-old female was referred to our hospital with left breast cancer and subsequently underwent mastectomy and axillary dissection. The pathological findings showed invasive breast cancer with lymph node metastasis (2/22), nuclear grade 3, ER (6+) PgR (2+) for the Allred score, and Her2 (2+) in an immunohistochemistry. We determined the subtype of Her2-negative breast cancer according to the fluorescent in situ hybridization results, as follows: Her2/CEP17 ratio 1.1 < 2.0. The patient received the EC regimen followed by docetaxel, and toremifene was subsequently administered. One year after the operation, the CA15-3 level was elevated at 50 ng/ml, and CT revealed liver metastases. Disease progression was not suppressed by paclitaxel containing regimen and eribulin. Then, we subsequently sought to determine whether the metastatic lesion showed the Her2 expression. Although the Her2 expression in the axillary lymph node metastases showed heterogeneous staining, the results were judged as Her2 (1+) according to the ASCO/CAP guidelines. We decided to administer trastuzumab and docetaxel due to the patient’s life-threatening status, after which the CA15-3 level decreased and the symptom of fatigue improved. A total of 9 cycles of trastuzumab and docetaxel were administered, followed by maintenance trastuzumab continued to the present time. Physicians should be aware of the statement in the ASCO/CAP guidelines that the clinical decision to ultimately consider Her2-targeted therapy should be individualized according to the patient’s status.