RESUMO
We report the case of a 42-year-old woman who was diagnosed with breast cancer that recurred 3 years later, with supraclavicular lymphadenopathy and dermal involvement. The main drug used in the therapy was trastuzumab; however, the association of this drug with docetaxel was not able to decrease or cease the effect of the inflammatory BCA component with erythema and thickening of the skin as well as the supraclavicular lymphadenopathy previously diagnosed. Thus, a combined therapy was required. The patient was started on 6 cycles (1 per month) of trastuzumab subcutaneous 600 mg, pertuzumab intravenous 840 mg (as an attack dose, later on 420 mg), and xeloda oral 1000 mg. As a result, the patient showed a significant improvement in erythema and thickening of the skin in the neck and the right part of her trunk, besides decrease in supraclavicular lymphadenopathy. After 6 cycles, her skin was almost restored. Intravenous trastuzumab can be an effective single agent; however, its association with other chemotherapies-such as pertuzumab-can present a synergic effect, which can increase the survival expectations of metastatic HER2+ patients. Additionally, as reported in the literature, the use of xeloda plays a key role in restoring the skin health of patients with breast cancer presenting with skin metastasis. Our findings suggest that trastuzumab, pertuzumab, and xeloda combined therapy, following the schedule and posology handled in this study, can be a good treatment for recurrent HER2+ breast cancer with signs of supraclavicular lymphadenopathy and severe inflammatory BCA component with erythema and thickening of the skin.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Capecitabina/administração & dosagem , Linfadenopatia/tratamento farmacológico , Trastuzumab/administração & dosagem , Administração Intravenosa , Administração Oral , Adulto , Esquema de Medicação , Feminino , Humanos , Injeções Subcutâneas , Metástase Neoplásica , Recidiva Local de Neoplasia/tratamento farmacológico , Receptor ErbB-2/biossíntese , Resultado do TratamentoRESUMO
El cáncer de mama es la neoplasia más frecuente en el sexo femenino, se diagnostican aproximadamente un millón de casos nuevos y 400 000 muertes en un año a nivel mundial.Caso clínico: se presenta el caso de una paciente con diagnóstico y tratamiento de cáncer de mama en el Hospital Oncológico Universitario María Curie de Camagüey. Se logró identificar el cáncer a través de la técnica de ganglio centinela, la cual se realiza hace varios años en el mundo como estándar en el tratamiento de cáncer mamario. Esta técnica puede realizarse con colorantes de azul de metileno, isosulfano ó por radio fármacos de medicina nuclear, lo que conlleva a evitar la disección radical axilar y con ello disminuye la morbilidad sin cambiar ó influir en el estadiamiento, tratamiento o sobrevida de la enfermedad
Breast cancer is the most frequent neoplasia in the female sex; approximately one million new cases are diagnosed and 400.000 annual deaths in woman worldwide.Clinical case: the case of a patient with diagnosis and treatment of breast cancer is presented in the University Oncological Hospital María Curie, Camagüey. Cancer has been identified through the sentinel node technique, which is performed for several years in the world as standard in breast cancer treatment. This technique may be done with colorings of methylene blue, isosulfan or by radiopharmaceuticals of nuclear medicine, which leads to avoid the axillary radical dissection and thereby decreases morbidity without changing or influencing in staging, treatment or disease survival
Assuntos
Humanos , Feminino , Adulto , Biópsia de Linfonodo Sentinela , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Relatos de CasosRESUMO
Fundamento: el cáncer mamario en una problemática creciente y desafiante para los servicios de salud en todo el mundo. Casos clínicos: se presenta la experiencia del diagnóstico y tratamiento del cáncer oculto de mama en tres pacientes en el Hospital Provincial Docente de Oncología de Camagüey. Esta enfermedad representa alrededor del 1 por ciento de todos los cánceres mamarios. Se muestra como una adenopatía ipsilateral sin nódulo mamario demostrable, el estadiamiento se hace dentro del sistema TNM tradicional con estadios que van desde una etapa IIb, hasta una IIIb. Hoy día se aplica una conducta quirúrgica diferente más centrada en el tratamiento de la axila, que evoluciona desde una mastectomía radical en cualquiera de sus variantes hasta sólo un vaciamiento axilar homolateral. En el Hospital Oncológico de Camagüey se diagnosticaron tres casos nuevos de carcinoma oculto de mama en los últimos dos años siendo tratadas diferente, debido a que la conducta frente a esta enfermedad sigue siendo controversial. Conclusiones: el presente trabajo demuestra la experiencia en el diagnóstico y tratamiento de esta enfermedad.
Background: breast cancer is a growing and defiant problem for health services in the entire world. Development: it is presented the experience on diagnosis and treatment of occult cancer of the breast at the Educational Provincial Oncology Hospital of Camagüey. This disease represents around 1 percent of all breast cancers. It is shown like an ipsilateral adenopathy without demonstrable mammary nodule; the staging is made inside the traditional TNM system with stages that goes from a IIb, until a IIIb. Nowadays a different surgical behavior is applied more centred in the treatment of the axilla that evolves from a radical mastectomy in any of its variants until only an homolateral axillary évidement. In the Oncological Hospital of Camagüey three new cases of occult carcinoma of the breast were diagnosed in the last two years which receive a different treatment, because the behavior in the face of this disease is still controversial. Conclusions: the present work demonstrates the experience in diagnosis and treatment of this disease.