|Year : 1999 | Volume
| Issue : 6 | Page : 267-269
Management of advanced breast cancer : A case report*
AK Gupta, JL Ticku
SS Veterans Hospital, Subroto Park, New Delhi 110 010., India
A K Gupta
SS Veterans Hospital, Subroto Park, New Delhi 110 010.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta A K, Ticku J L. Management of advanced breast cancer : A case report*. Indian J Med Sci 1999;53:267-9
Breast cancer is common and its incidence is increasing. Survival curve steeply falls after stage 11 disease because the disease is considered to become systemic. Advanced (metastatic) cancer is a terminal disease : inevitably the patient relapse on whatever treatment is administered. Overall survival does not increase, but the aim of treatment is to improve the quality of life. Nevertheless with advance treatment number of effected women may survive for many years i.e. median survival of women presenting with stage IV breast cancer was 41 months reported by Paterson  Current therapy therefore focuses on palliation, trying to prolong the remaining life span while minimising any discomfort from either treatment or disease.
Case Report: Perimenopausal 46 years old female case of cancer right breast grade III with deposits in lymphnodes (12/14) including right apical lymphnode (T310M0 ) diagnosed in March 94. She was treated with simple mastectomy with axillary clearance (Oncosurgery) followed by 4 pulses of Chemotherapy (Cyclophosphamide, Methotrexate and 5 FU) and radiation (external radiation to chest wall and drainage area) completed by Nov 94. Histopathologicaly it was infiltrative duct carcinoma and breast tissue was stained immunocyto-chemically with monoclonal antibodies for estrogen and progestron receptors. Semiquentatinely ER and PR postinity was one plus (reactivity was scaled from 0 to 3 plus). She was advised tamoxifen 20 mgm daily as a prophylatic drug for recurrence. Since then she was in remmission. In Nov 97 she reported with pain chest and was found to have maligent Rt sided pleural effusion. On further evaluation secondary deposits detected in liver (USG followed by CT abdomen) and bonny metastatic deposit in D 12 (Isotope bone scan). She was treated with salvage chemotherapy (Texol and Cisplatin) and intrapleural installation of bleomycin. Among adjuvant endocrine therapy tamoxifen was stopped and denazol 200 mgm per day was given as a prophylatic measure for further distant metastasis. By Feb 98, she became asymptomatic, pleural effusion disappeared and ultrasonographically metastatic deposits in liver had also disappeared. After 4th pulse of chemptherapy in end of Feb. she had bonemarrow depression (neutropenia, TLC 1430 per microlitre with 21% neutrophils i.e. absolute neutrophil count 301) managed with leucomex (rHu GM-CSF). Her serum marker Ca- 15-3 was with in normal Emits, so further no antimitotic drug was given and was only considered for hormone therapy. Since then she was in remission end was taking only danazol orally.
On routine follow up, in June 98, a subcutanous painless hard nonodule was detected in right side of chest. On biopsy followed by H/P examination it was found to besecondary metastatic deposits and on futher evaluation liver again showed solitary hypoechoic (1.0 cm x 0.9 cm) shadow ultra-sonographically probably again secondary deposits. Denazol stopped and she was again considered for chemotherapy (Oncotran, vincristin and carboplatin) with aromatose inhibitor as adjuvant endocrine therapy. 2 pulses during the past two months were advocated and patient is tolerating well. Latest USG abdomen revealed same size of solitary hypoechoic shadow in liver. Presently patient as asymptomatic and leading her normal life.
| ¤ Discussion|| |
Management of breast cancer is major health care priority. Apart from Oncosurgery and radiotherapy there is a role of systemic therapy in the form of chemo and endocrine therapy, specially in the treatment of distant metastasis. Adjuvant therapies are mainly systemic, likely to achieve long term control of disease throughout the body. Similarly combination of drugs induces higher response rate and improved survival compared with serial treatment. Relapse of failure of response to a specific endocrine treatment usually occur within two years. , Response to first Line treatment last only for 9-12 months in oestrogen receptor positive metastatic breast cancer (or 2-3 years in micrometastatisis). However repeated response can be achieved by using a sequence of endocrine agents with different modes of action, although the duration of response and the type and extent of remmission in most of the cases gradually decline.  For the management of recurrence of distant metastasis change in cytotoxic drug and endocrine therapy is required to avoid drug resistance and their toxic effects. In such cases aim of the treatment is to prolong the life span by palliaive measures which should be effective and well tolerated. In this case, when the presented in relapse with secondary metastasis after 3 years, she was managed with different regimen of chemo and endocrine therapy. After 4th pulse her hepatic deposits and pleural effusion disappeared (ultrasonographically) and she went into remmission. After 3 months, again whe she presented with secondary deposits (hepatic and bonny), she was managed with different cytotoxic drugs and changed endocrine therapy, Again she tolerated and responded very well. Thus our aim in such patients should be to provide maximum comfort and improve the life span quantitatively and qualitatively only by palliative measures which should be effective and well tolerated.
| ¤ References|| |
|1.||Paterson AH. The natural history breast cancer and the impact of systemic therapy. In : Powles TJ, Smith IE (ed) : Medical management of breast cancer. Dunitz, London, 1991. |
|2.||Commbes RC. Clinical studies with 4-hydroxyandros-tenedione in advanced cancer. In : Commbes RC, Dowsett M (eds) 4-hydroxyandrostenedione - a new approach to hormone depenent cancer. Int Cong and Sympos Series, Royal Soc Med Services Ltd. London, 1991. |
|3.||Stein RC, Dowsett M, Hedley A. Treatment of advanced breast cancer in postmenopausal women with 4 hydroxyandrostenedione. Cancer Chemother Pharmacol, 1990;26: 75-73. |
|4.||Smith JE, Harris AL, Morgan M. Tamoxifen versus aminoglutethimide in advanced breast carcinoma: a randomised cross-over trial. Br Med J 198Y;283:1432-1434. |