YO1 - Is metastatic breast cancer curable?

Case summary

Metastatic breast cancer (MBC) remains a largely incurable disease. However, some cases of MBC with long-term relapse-free survival are seen, implying that a small subset of MBC patients could be curable. We report the case of a HER2 positive and HR negative breast cancer patient who was diagnosed with multiple visceral and skeletal metastases and is alive without evidence of active disease at the end of 8 years. Sixty years old female with no comorbidities was evaluated for a lump in right breast in mid-July 2011. True cut biopsy from the lump confirmed the diagnosis of high-grade infiltrating ductal carcinoma. The tumor was negative for ER, PR expression, HER2 amplification was noted on the FISH test. Computed tomography (CT) showed a mass lesion in the right breast of 4.5 cm multiple lungs lesions (largest of size 5.6 cm), multiple hepatic lesions (largest of 11.5 cm), multiple enlarged mediastinal, axillary, retroperitoneal lymph nodes and D7 vertebral lytic lesion with partial collapse. The patient was treated with combination therapy including paclitaxel (80mg per meter square) and trastuzumab (4mg per kg) at the interval of every week. After completion of 6 cycles, CT scan in Dec 2011 showed significant regression in size of metastatic lesions at all the sites with a residual hepatic lesion of 5.2cm. Further continuation of Trastuzumab and Paclitaxel was deferred in view of prohibitive cost. She received palliative radiotherapy to the right breast in Jan 2012. In view of extensive disease at diagnosis and inability to continue with conventional systemic therapy options, oral metronomic chemotherapy (OMCT) methotrexate, cyclophosphamide and metformin were prescribed. She tolerated OMCT well with no evidence of progressive disease over the next 3 years. OMCT was discontinued after an episode of prolonged thrombocytopenia in Apr 2015. Thereafter patient did not receive any anticancer therapy. Her recent PET CT showed no FDG avid lesion. Thus, she remains to be disease-free at the end of 8 years and possibly cured of her MBC.

This case raises our hopes for the cure in patients with metastatic her 2 positive breast cancer. Newer antiHer2 agents and chemotherapy form an integral part of our efforts towards long term disease control; however role OMCT in MBC needs to be explored further.

Clinical trial identification

Editorial acknowledgement