J Breast Cancer.  2014 Sep;17(3):287-290. 10.4048/jbc.2014.17.3.287.

Combined Antiangiogenic and Mammalian Target of Rapamycin Inhibitor Targeted Therapy in Metaplastic Breast Cancer Harboring a PIK3CA Mutation

• Agarwal R
• Koenig K
• Rohren E
• Subbiah V

• KMID: 2286357
• DOI: http://doi.org/10.4048/jbc.2014.17.3.287

Abstract

Metaplastic breast cancer (MpBC) is an extremely rare breast cancer subtype, characterized by a heterogeneous phenotype. MpBC aggressive biology is attributed to its stem cell-like characteristics. Since these tumors are largely chemoresistant, novel targeted therapies should be explored. Herein, we report the clinical course of a 59-year-old African American woman with MpBC with a PIK3CA mutation in codon 545, exon 10 (GAG to AAG; p.Glu545Lys) and a TP53 mutation in codon 286, exon 8 (GAA to AAA; p.Glu286Lys). The same mutations were observed in the primary and secondary sites. The patient was treated with a molecularly matched therapy using a combined antiangiogenic and mammalian target of rapamycin kinase inhibitor strategy that included liposomal doxorubicin, bevacizumab, and temsirolimus. Partial remission was achieved. In this report, the scientific rationale underlying the activity of this combination was explored. In conclusion, patients may benefit from being offered molecular profiling early during the course of the disease to receive a therapy guided accordingly.

Keyword

Bevacizumab; Breast neoplasms; PIK3CA protein; Tumor suppressor protein p53

MeSH Terms

Biology
Breast Neoplasms*
Codon
Doxorubicin
Exons
Female
Humans
Middle Aged
Phenotype
Phosphotransferases
Sirolimus*
Tumor Suppressor Protein p53
Bevacizumab
Codon
Doxorubicin
Phosphotransferases
Sirolimus
Tumor Suppressor Protein p53

Figure

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  Figure 1 Pretreatment fluorodeoxyglucose positron emission tomography/computed tomography of the patient showing multiple hypermetabolic pulmonary metastasis and hypermetabolic adenopathy in the thorax.

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  Figure 2 Positive positron emission tomography/computed tomography response after two cycles of combination therapy with liposomal doxorubicin, bevacizumab, and temsirolimus.

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  Figure 3 Pretreatment and posttreatment maximum intensity projection image and coronal images of the patient. Pretreatment maximum intensity projection image and coronal image showing hypermetabolic pulmonary metastasis and lymphadenopathy (A, B). Posttreatment maximum intensity projection image and coronal image showing response to therapy after two cycles of combination of liposomal doxorubicin, bevacizumab, and temsirolimus (C, D).

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