Abstract
We encountered a case of inflammatory local recurrence of breast cancer after breast conserving surgery which attained pathological CR after combination therapy with trastuzumab and paclitaxel. The patient was a 49-year-old premenopausal woman whose left breast cancer (T2N0M0) was treated by breast conserving surgery (Bp + Ax). The pathological diagnosis was scirrhous carcinoma, g, ly1, v0, t2, n0, ER (−), PgR (+) and stage IIA. Postoperatively, the residual breast was treated by 50 Gy irradiation followed by hormone therapy (Tamoxifen citrate + LH-RH analog). At 26 months after the surgery, local recurrence developed as inflammatory breast cancer. As the recurrent tumor was confirmed to be HER2-positve (3+ by IHC), combination therapy with trastuzumab and paclitaxel was started. After the 6 courses of pharmacotherapy were completed, she was judged to have clinical CR, and subsequently underwent total breast excision (Bt) and skin grafting. No visible cancer cell was observed in the resected specimens, pathological CR was diagnosed. Postoperatively, the patient is receiving trastuzumab alone every other week, and at present 10 months after the second operation, the patient is in CR status and is visiting the outpatient clinic. No severe side effects (over grade 3) from this therapy have been observed. It is suggested that combination therapy with trastuzumab and paclitaxel for inflammatory local recurrence after breast conserving surgery is a treatment of choice.
Abbreviations
- CR:
-
Complete remission
- HER2:
-
Human epidermal growth factor receptor 2
- IHC:
-
Immunohistochemistry
- AC:
-
Antnracycline + Cyclophosphamide
References
Gage I, Schnitt SJ, Recht A, Abner A, Come S, Shulman LN, Monson JM, Silver B, Harris JR, Connolly JL: Skin recurrences after breast-conserving therapy for early-stage breast cancer.J Clin Oncol 16: 480–486, 1998.
Fendly BM, Winget M, Hudziak RM, Lipari MT, Napier MA, Ullrich A: Characterization of murine monoclonal antibodies reactive to either the human epidermal growth factor receptor or HER2/neu gene product.Cancer Res 50: 1550–1558, 1990.
Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L: Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2.N Engl J Med 344: 783–792, 2001.
Piccart-Gebhart MJ: HerceptinR: the future in adjuvant breast cancer therapy.Anti-Cancer Drugs 12 (suppl 4): S27-S33, 2001.
Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E, Saffer E, Wickerham L, Lerner H, Glass A, Shibata H, Deckers P, Ketcham A, Oishi R, Russell I: Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of the breast cancer.N Engl J Med 312: 665–673, 1985.
Abner AL, Recht A, Eberlein T, Come S, Shulman L, Hayes D, Connolly JL, Schnitt SJ, Silver B, Harris JR: Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer.J Clin Oncol 11: 44–48, 1993.
Fisher ER, Sass R, Fisher B, Gregorio R, Brown R, Wickerham L, NSABP Investigators: Pathologic findings from the National Surgical Adjuvant Breast Project (Protocol 6). II. Relation of local breast recurrence to multicentricity.Cancer 57: 1717–1724, 1986.
Kurtz JM, Jacquemier J, Brandone H, Ayme Y, Hans D, Bressac C, Spitalier JM: Inoperable recurrence after breast-conserving surgical treatment and radiotherapy.Surg Gynecol Obstet 172: 357–361, 1991.
Nishimura R, Koyama H, Kasumi F, Takashima S, Kobayashi S, Komaki K, Ohkawa T, Shin E, Kodama H, Fukutomi T, Nishi T, Sonoo H, Sano S, Kimishima I, Nakaue K, Nakamura S, Kusama M, Okumura K: A case control study on risk factors involved in inflammatory breast recurrence after breast-conserving surgery.Oncology 55: 391–399, 1998.
Voogd AC, Peterse JL, Crommelin MA, Rutgers EJT, Botke G, Elkhuizen PHM, Geel AN, Hoekstra CJM, Pel R, Vijver MJ, Coebergh JWW, Dutch Study Group on Local Recurrence after Breast Conservation (BORST): Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer.Eur J Cancer 35: 1828–1837, 1999.
Marret H, Perrotin F, Bougnoux P, Giraudeau B, Hubert B, Fetissof F, Le Floch O, Lansac J, Body G: Histologic multifocality is predictive of skin recurrences after conserving treatment of stage I and II breast cancers.Breast Cancer Res Treat 68: 1–8, 2001.
Saltzstein SL: Clinically occult inflammatory carcinoma of the breast.Cancer 34: 382–388, 1974.
Amparo RS, Angel CDM, Ana LH, Antonio LC, Vicente MS, Carlos FM, Vicente GM: Inflammatory breast carcinoma: pathological or clinical entity?Breast Cancer Res Treat 64: 269–273, 2000.
Seidman AD, Fornier MN, Esteva FJ, Tan L, Kaptain S, Bach A, Panageas KS, Arroyo C, Valero V, Currie V, Gilewski T, Theodoulou M, Moynahan ME, Moasser M, Sklarin N, Dickler M, D’Andrea G, Cristofanilli M, Rivera E, Hortobagyi GN, Norton L, Hudis CA: Weekly trastuzumab and paclitaxel therapy for metastatic breast cancer with analysis of efficacy by HER2 immunophenotype and gene amplification.J Clin Oncol 19: 2587–2595, 2001.
Dieras V, Beuzeboc P, Laurence V, Pierga JY, Pouillart P: Interaction between HerceptinR and taxanes.Oncology 61 (suppl 2): 43–49, 2001.
Leyland-Jones B, Smith I: Role of HerceptinR in primary breast cancer: views from North America and Europe.Oncology 61 (suppl 2): 83–91, 2001.
Slamon D, Pegram M: Rationale for trastuzumab (Herceptin) in adjuvant breast cancer trials.Semin Oncol 28 (suppl 3): 13–19, 2001.
Author information
Authors and Affiliations
About this article
Cite this article
Nomura, M., Inoue, Y., Fujita, S. et al. Pathological complete response to trastuzumab and paclitaxel in a patient with inflammatory local recurrence following breast conserving surgery. Breast Cancer 12, 226–230 (2005). https://doi.org/10.2325/jbcs.12.226
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.2325/jbcs.12.226