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Response to Abemaciclib After 10 Lines of Therapy Including Palbociclib in Metastatic Breast Cancer: A Case Report With Literature Review.

ABSTRACT: Metastatic breast cancer (BC) is considered incurable, and it is generally treated with sequential single-agent therapies to control it with palliative intent. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) are used in the front-line setting of hormone receptor (HR)-positive, HER2-negative BC, and guidelines discourage the use of a second-line CDK4/6i after failure of first-line use of this class of drugs due to lack of data supporting this practice. We report a case of a postmenopausal woman with HR-positive and HER2-negative advanced BC who was treated with four lines of hormonal therapy and more than five chemotherapy regimens, with progression. Palbociclib was used in the sixth-line therapy and discontinued after 5 months. We then tried abemaciclib in the 11th-line setting, where it induced a response that lasted 16 months.

SUBMITTER: Wender IO

PROVIDER: S-EPMC7683665 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Response to Abemaciclib After 10 Lines of Therapy Including Palbociclib in Metastatic Breast Cancer: A Case Report With Literature Review.

Wender Isabella O IO Haines Kayla K Jahanzeb Mohammad M

Oncology and therapy 20200902 2

Metastatic breast cancer (BC) is considered incurable, and it is generally treated with sequential single-agent therapies to control it with palliative intent. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) are used in the front-line setting of hormone receptor (HR)-positive, HER2-negative BC, and guidelines discourage the use of a second-line CDK4/6i after failure of first-line use of this class of drugs due to lack of data supporting this practice. We report a case of a postmenopausal woman ...[more]

PMID: 32876928

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Project description:Breast cancer is a significant global health concern, contributing to substantial morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2-negative (HER2-) breast cancer constitutes a considerable proportion of cases, and significant advancements have been made in its management. CDK4/6 inhibitors (CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant, advanced and metastatic settings. The propensity of lobular breast carcinomas for estrogen-rich sites, such as periocular tissues and orbital fat, may explain their tendency for orbital metastases. Current treatment strategies for these cases are predominantly palliative, and the prognosis remains poor. This article presents a unique case of a 51-year-old female with progressive right periorbital edema, pain, and limited ocular motility. An imaging work-up showed bilateral intra and extraconal orbital infiltration, which was biopsied. The histopathologic analysis disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7 markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A systemic evaluation showed a multicentric nodular formation in both breasts. Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast carcinoma with synchronous bilateral orbital metastases. Systemic treatment was initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day. However, this regimen was interrupted due to toxicity. After two weeks, treatment was resumed with a reduced abemaciclib dose (100mg twice daily) alongside letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of inoperable metastatic cancer, the patient remains on the same systemic treatment regimen with no signs of invasive disease. This case report is the first of a patient presenting with bilateral orbital metastases from bilateral lobular breast cancer, showing an impressive and sustained response to a first-line treatment regimen combining abemaciclib and letrozole. A literature review on bilateral orbital metastases from breast cancer is also presented.

Dataset Information

Response to Abemaciclib After 10 Lines of Therapy Including Palbociclib in Metastatic Breast Cancer: A Case Report With Literature Review.

Publications

Response to Abemaciclib After 10 Lines of Therapy Including Palbociclib in Metastatic Breast Cancer: A Case Report With Literature Review.

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