Liver Metastasis of a Triple-Negative Breast Cancer and Complete Remission for 5 Years After Treatment With Combined Bevacizumab/Paclitaxel/Carboplatin

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CASE PRESENTATION

Our institutional review board considered the approval was not required for this case report since written informed consent was obtained from the patient.

In June 2009, a 34-year-old woman was diagnosed with cancer of the right breast during her 28th week of pregnancy. Her family included several members with breast cancer and 1 with prostate cancer, suggesting likely genetic dispositions. Mastectomy was performed during the 29th week of pregnancy and axillary lymph nodes were resected. Subsequent pathological examinations of the surgical specimen revealed an invasive ductal carcinoma of 28 × 20 mm with the diagnostic characteristics ly+, v+, nuclear grade 2, lymph node metastasis (level I 1/10), ER-negative, PgR-negative, and HER2-negative. The fetus was developing normally immediately before surgery, with appropriate-for-date fetal weight of 1552 g at 29 weeks of gestation. In August 2009, a caesarean section was performed at 35 gestational weeks and a male with no physical or neurological abnormalities was delivered (birth weight 2311 g and APGAR scores of 7 and 8 at 1 and 5 min, respectively). Although temporary artificial respiration was required, the infant’s development was normal and he was discharged from the hospital at 45 days after delivery.

Abdominal computed tomography scans of the patient were performed immediately after delivery, and multiple low-density masses were detected in both liver lobes (Figure ​(Figure1).1). Subsequent abdominal magnetic resonance imaging indicated the presence of liver metastases of the breast cancer (Figures ​(Figures22 and ​and3).3). Thus, a multidisciplinary discussion involving breast surgeons, hepato-biliary-pancreatic surgeons, oncologists, obstetricians, radiologists, pathologists, and nursing staff was held to formulate a management plan for the patient, and systemic therapy containing bevacizumab was prescribed. Although the patient accepted the decision, bevacizumab had not been approved in Japan for the treatment of breast cancer at that time (August 2009). Because our hospital is licensed only to provide medical care that is underwritten by the national healthcare system, it was not possible to offer this treatment. Therefore, the patient was referred to a facility that was not underwritten by the national healthcare system, and BPC therapy was initiated on August 27, 2009. Upon commencement of treatment, lung, liver, kidney, and heart functions were all within normal limits, and the patient’s Eastern Cooperative Oncology Group performance status was 0.

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Therapy comprised intravenous administration of 6 courses of BPC over a 28-day cycle, and 2 mg/kg bevacizumab was administered on days 1 and 8, followed by 4 mg/kg on day 15. Paclitaxel (80 mg/mm2) was administered on days 1, 8, and 15, and carboplatin (area under the curve, 2.0 mg/mL per min) was administered on days 1, 8, and 15. Neoplastic lesions had disappeared after completion of the sixth course of BPC and cavitation was observed in S7 of the metastatic lesions. Side effects during therapy included grade 3 leukopenia, grade 1 peripheral neuropathy, general lethargy, and diarrhea, but no fever occurred during therapy. In 2014, the patient consented to direct genetic sequencing of the BRCA2 gene and a 6781delG mutation was identified. After completion of the sixth course of BPC therapy, no other additional treatment was given. At the most recent follow-up in 2014 (5 years after the start of treatment), no recurrence of liver lesions (Figures ​(Figures22 and ​and4)4) or new metastases to any other area were observed (Figure ​(Figure5)5) and the patient reported a good quality of life.

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About the Author: Tung Chi