J Breast Cancer.  2019 Dec;22(4):647-652. 10.4048/jbc.2019.22.e50.

Clinical Effects of Hypomethylating Agents in Patients with Newly Diagnosed Myelodysplastic Syndrome Who Received DNA-Damaging Chemotherapy for Metastatic Breast Cancer

• Baek DW
• Lee SJ
• Sohn SK
• Moon JH
• Chae YS

• KMID: 2470901
• DOI: http://doi.org/10.4048/jbc.2019.22.e50

Abstract

The cumulative risk of therapy-related myelodysplastic syndrome (t-MDS) in breast cancer patients exposed to chemotherapy and/or radiotherapy is significantly high compared to that in other cancer patients. This report reviews the use of hypomethylating agents (HMAs) to treat a 57-year-old woman newly diagnosed with MDS during palliative chemotherapy for metastatic breast cancer. Over a period of 6 years, the patient received several DNA-damaging chemotherapeutics including doxorubicin, cyclophosphamide, and paclitaxel. Repeated thrombocytopenia was the main reason for suspecting secondary hematologic malignancy. She was diagnosed with t-MDS based on bone marrow examination and her treatment history for breast cancer. While azacitidine was originally administered to stabilize MDS, it also stabilized the patient's lung and lymph node metastases without any major toxicity. Therefore, the current case highlights the promising effects of HMAs for treating t-MDS following heavily pretreated breast cancer.

Keyword

Azacitidine; Breast neoplasms; DNA methylation; Myelodysplastic syndrome

MeSH Terms

Azacitidine
Bone Marrow Examination
Breast Neoplasms*
Breast*
Cyclophosphamide
DNA Methylation
Doxorubicin
Drug Therapy*
Female
Hematologic Neoplasms
Humans
Lung
Lymph Nodes
Middle Aged
Myelodysplastic Syndromes*
Neoplasm Metastasis
Paclitaxel
Radiotherapy
Thrombocytopenia
Azacitidine
Cyclophosphamide
Doxorubicin
Paclitaxel

Figure

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  Figure 1 Treatment history for breast cancer.

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  Figure 2 Improved platelets after hypomethylating agent therapy. t-MDS = therapy-related myelodysplastic syndrome; HMA = hypomethylating agent.

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  Figure 3 Chest computed tomography (CT) scan before (August 2018) and after (April 2019) the azacitidine (AZA) treatment. (A) Multiple lung metastases (arrow) were found in the chest CT scan. (B) After 4 cycles of AZA, size of right upper lung mass was decreased (arrowhead).

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