Yeungnam Univ J Med.  2020 Jul;37(3):230-235. 10.12701/yujm.2019.00423.

Impressive effect of cisplatin monotherapy on a patient with heavily pretreated triple-negative breast cancer with poor performance

• Baek DW
• Park JY
• Lee SJ
• Chae YS

• KMID: 2506523
• DOI: http://doi.org/10.12701/yujm.2019.00423

Abstract

Systemic therapy for metastatic triple-negative breast cancer (TNBC) still remains challenging because there are no targeted agents or endocrine therapies currently available. The present case report documents the successful use of cisplatin monotherapy to manage a heavily pretreated TNBC patient showing poor response to therapy. The patient was a 51-year-old woman who had already undergone several lines of systemic chemotherapy for widespread TNBC. Although the mutation analysis performed on DNA isolated from blood cells and progressed lesion samples confirmed the tumor to be germline BRCA wild-type, cisplatin monotherapy was administered based on the increasing evidence of safety and efficacy of platinum for breast cancer. After three cycles of cisplatin treatment, the patient’s metastatic lesions dramatically improved without any major toxicity, and she completed 17 cycles with good response. This case study indicates that patients with heavily pretreated TNBC can potentially achieve a good response to cisplatin monotherapy.

Keyword

Antineoplastic agents; Cisplatin; DNA repair; Triple negative breast neoplasms

Figure

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  Fig. 1. Heavily pretreated breast cancer with widespread skin metastases on July 2017. At the time of admission to our hospital, the patient was suffering from severe skin metastases with discharge (A, B). Positron emission tomography-computed tomography shows breast cancer with multiple metastases in the chest wall, liver, bone, and lymph nodes (C). The patient provided written informed consent for publication of clinical details and images.

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  Fig. 2. Representative histological features and immunohistochemical (IHC) findings of the metastatic carcinoma. The metastatic tumor shows the histologic grade 3, according to the modified Nottingham grading system (tubule formation 3, nuclear pleomorphism 3, and mitotic activities 2), and frequent lymphovascular emboli (A, arrowheads) within the dermal area (A, B). The tumor cells shows 10% Ki-67 labeling index (C), loss of estrogen receptor (D), and progesterone receptor (E). The expression of HER2 was classified as 2+ (F) on IHC, subsequently proven HER2 negativity on HER2 silver in situ hybridization (not shown) (hematoxylin and eosin stain, ×40 [A, B]; IHC stain, ×200 [C−F]).

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  Fig. 3. Before the cisplatin treatment, the patient complained of widespread skin metastases with discharge and generalized edema (A). She received 75 mg/m2 of cisplatin every 3 weeks, along with standard hydration and antiemetic prophylaxis. After three cycles of cisplatin, skin ulcerative lesions were remarkably decreased (B). After six cycles of the regimen, responses were further noted in skin lesions as well as liver, chest wall, and lymph nodes (C). The patient completed her 17th cycle of cisplatin with dramatic metastatic skin lesion improvement (D, E). The patient provided written informed consent for publication of clinical details and images.

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  Fig. 4. Computed tomography (CT) shows the impressive response of cisplatin monotherapy. Before the cisplatin monotherapy, multiple metastases with bilateral pleural effusion (arrows) were found in the chest and abdomen CT (July 2017) (A). Pleural effusion and metastatic lesions were dramatically improved (arrowheads) after the cisplatin treatment (December 2018) (B).

Reference

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