内容紹介
Long-Term Effect of Fulvestrant for Locally Advanced Breast Cancer in an Elderly Patient―A Case Report
Summary
We report an elderly patient with locally advanced breast cancer who received long-term fulvestrant therapy. The patient was a 75-year-old woman who presented with a right breast lump. She noticed the tumor 4 years and 6 months ago, but she had not visited any hospital. However, her daughter brought her to our hospital. The tumor was 73 mm in diameter. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu. The Ki-67 positive cell index was 20%. We performed a whole-body checkup, and confirmed the diagnosis as T4cN1M0, Stage ⅢB. She initiated endocrine therapy by letrozole(2.5 mg/day). After 1 year and 6 months, tumor marker levels increased. We changed the endocrine therapy to fulvestrant(500 mg/month). For the next 2 years and 6 months, this therapy was effective. Her axillary lymph node metastases disappeared and tumor size decreased(60%). She underwent muscle-preserving mastectomy plus axillary lymph node dissection. The pathological diagnosis from the resected surgical specimen was confirmed as invasive ductal carcinoma, positive for ER and PgR, and negative for HER2/neu protein expression. The surgical margins were negative, and there was no metastasis in the lymph nodes. She was administered adjuvant endocrine therapy. Four years after surgery, she was well without metastasis.
要旨
長期間にわたるfulvestrantによる内分泌療法が奏効し,切除が可能となった高齢者局所進行乳癌を経験した。症例は75歳,女性。右乳房に腫瘤を触知して来院した。来院時,腫瘍は直径70 mmであり皮膚潰瘍を伴い,胸筋固定を認めた。造影CT検査では右乳房に73 mmの皮膚・胸壁に浸潤する腫瘍を認めたが他臓器転移は認めなかった。針生検で浸潤性乳管癌,ER陽性,PgR陽性,HER2陰性,Ki-67 20%と診断された。T4cN1M0,Stage ⅢBと診断され,letrozole(2.5 mg/day)の内服を開始したが,腫瘍マーカーの上昇傾向を認めた。fulvestrantに変更して治療を継続したところ,腫瘍に縮小傾向を認めた。2年6か月後には腫大した腋窩リンパ節は消失,腫瘍径も60%まで縮小し,易出血性も改善した。胸筋温存乳房切除術+腋窩リンパ節郭清術を施行した。術後4年目の現在,明らかな局所再発・遠隔転移を認めていない。
目次
Summary
We report an elderly patient with locally advanced breast cancer who received long-term fulvestrant therapy. The patient was a 75-year-old woman who presented with a right breast lump. She noticed the tumor 4 years and 6 months ago, but she had not visited any hospital. However, her daughter brought her to our hospital. The tumor was 73 mm in diameter. A core needle biopsy for breast tumor led to a diagnosis of an invasive ductal carcinoma, positive for estrogen receptor(ER)and progesterone receptor(PgR), and negative for HER2/neu. The Ki-67 positive cell index was 20%. We performed a whole-body checkup, and confirmed the diagnosis as T4cN1M0, Stage ⅢB. She initiated endocrine therapy by letrozole(2.5 mg/day). After 1 year and 6 months, tumor marker levels increased. We changed the endocrine therapy to fulvestrant(500 mg/month). For the next 2 years and 6 months, this therapy was effective. Her axillary lymph node metastases disappeared and tumor size decreased(60%). She underwent muscle-preserving mastectomy plus axillary lymph node dissection. The pathological diagnosis from the resected surgical specimen was confirmed as invasive ductal carcinoma, positive for ER and PgR, and negative for HER2/neu protein expression. The surgical margins were negative, and there was no metastasis in the lymph nodes. She was administered adjuvant endocrine therapy. Four years after surgery, she was well without metastasis.
要旨
長期間にわたるfulvestrantによる内分泌療法が奏効し,切除が可能となった高齢者局所進行乳癌を経験した。症例は75歳,女性。右乳房に腫瘤を触知して来院した。来院時,腫瘍は直径70 mmであり皮膚潰瘍を伴い,胸筋固定を認めた。造影CT検査では右乳房に73 mmの皮膚・胸壁に浸潤する腫瘍を認めたが他臓器転移は認めなかった。針生検で浸潤性乳管癌,ER陽性,PgR陽性,HER2陰性,Ki-67 20%と診断された。T4cN1M0,Stage ⅢBと診断され,letrozole(2.5 mg/day)の内服を開始したが,腫瘍マーカーの上昇傾向を認めた。fulvestrantに変更して治療を継続したところ,腫瘍に縮小傾向を認めた。2年6か月後には腫大した腋窩リンパ節は消失,腫瘍径も60%まで縮小し,易出血性も改善した。胸筋温存乳房切除術+腋窩リンパ節郭清術を施行した。術後4年目の現在,明らかな局所再発・遠隔転移を認めていない。