Ewha Med J.  2015 Oct;38(3):138-143. 10.12771/emj.2015.38.3.138.

Long-term Complete Response with Lapatinib Plus Capecitabine in a Patient with HER2-Positive Breast Cancer Metastasized to the Pancreas

• Shin K
• Kim J
• Yoon S
• Cho EH
• Jung C
• Kang HJ

• KMID: 2171353
• DOI: http://doi.org/10.12771/emj.2015.38.3.138

Abstract

A 37-year-old woman underwent a total mastectomy and adjuvant chemotherapy for HER2-positive breast cancer (pT1N0M), and then recurred in the right lung followed by the pancreas. Lung lobectomy and pylorus-preserving pancreaticoduodenectomy were performed, and systemic chemotherapies including trastuzumab were sequentially administered. However, metastasis to the pancreatic tail was detected. She underwent image-guided radiation therapy, but this was not effective. Lapatinib plus capecitabine combination was administered as forth-line treatment and the metastatic lesion was disappeared. She is continuing this regimen with a complete response for 48 months until now.

Keyword

Breast neoplasms; Lapatinib; Capecitabine; Pancreas

MeSH Terms

Adult
Breast Neoplasms*
Breast*
Chemotherapy, Adjuvant
Drug Therapy
Female
Humans
Lung
Mastectomy, Simple
Neoplasm Metastasis
Pancreas*
Pancreaticoduodenectomy
Radiotherapy, Image-Guided
Tail
Capecitabine
Trastuzumab

Figure

• 

  Fig. 1 Microscopic findings of resected specimen. (A) Primary breast cancer is composed of nuclear grade 2 invasive ductal carcinoma and comedo type ductal carcinoma in situ (H&E, ×100). Immunohistochemically, the tumor cells are negative for estrogen receptor (B) and progesterone receptor (C) but positive for C-erbB2 (D) (×200).

• 

  Fig. 2 Radiologic and microscopic findings of pulmonary nodule. (A) A chest computed tomography scan shows a single nodule in the lower lobe of the right lung (black arrow). (B) An 18F-fluorodeoxyglucose positron emission tomography computed tomography scan shows no distant metastasis except to the lung. (C) Microscopically, tumor cells are arranged in a nest-like pattern in the alveolar spaces (H&E, ×100). (D) Tumor cells are immunoreactive for C-erbB2 (×200).

• 

  Fig. 3 Radiologic and microscopic findings of pancreatic head lesion. (A) An 18F-fluorodeoxyglucose positron emission tomography computed tomography scan shows a hypermetabolic lesion (standardized uptake value, 7.7) in the pancreatic head. (B) This lesion is a low-attenuating mass (1.5 cm) on an abdominal-pelvic computed tomography scan. (C) Microscopically, the tumor cells show a small nest-like pattern with infiltrative features in the fibrous stroma (H&E, ×100). (D) Tumor cells are strongly immunoreactive for C-erbB2 (×200).

• 

  Fig. 4 Radiologic findings of pancreatic tail lesion with complete response. The pancreatic tail mass has been initially shown as a hypermetabolic lesion (standardized uptake value, 3.3) on an 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET-CT) scan (A) and as a low-attenuating lesion (1.5 cm) on an abdominal-pelvic CT scan (C). After image-guided radiation therapy of 45 Gy, enlarged mass is shown (D). However, after combination chemotherapy with lapatinib and capecitabine, this pancreatic tail mass disappeared on 18F-FDG PET-CT (B) and CT (E) scans.

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