内容紹介
A Case of Male Breast Cancer for Which mTOR Inhibitor Was Effective with Advanced Renal Cancer
Summary
A 43-year-old man complained of back hip pain and of a 2 cm palpable mass of the left breast. The results from a careful examination were left breast cancer, a left renal cancer, and metastases to lung, bone and pleura. As a result of discussion with a urologist, the left breast cancer was followed-up, and the left advanced renal cancer cT4N0M1-stage Ⅳ received chemotherapy by sunitinib. In sunitinib therapy, we recognized some adverse events of Grade 3. The left renal cancer became a progressive-disease. Therefore, we changed chemotherapy to an mTOR inhibitor, temsirolimus. The left renal cancer was long SD-PD by treatment of temsirolimus, and the left male breast cancer was improved. Sunitinib is a tyrosine kinase inhibitor for multi-targets including VEGFR, PDGFR, c-kit et. There are some reports about breast cancer, but there are no results yet superior to those obtained by conventional therapy. On the other hand, a mTOR inhibitor, temsirolimus, was reported to have a synergy effect with hormone therapy for breast cancer. Concerning everolimus, which is one of the mTOR inhibitors, it was reported that results from the SERM+everolimus combination group were superior to those from the SERM alone group for postmenopausal metastatic breast cancer patients in clinical trial(TAMRAD trial). Good results are also being reported now from BOLERO-2(exemestane+/-everolimus), which is undergoing clinical trials. Therefore, everolimus is promising as a therapeutic drug for ER-positive breast cancer.
要旨
症例は43歳,男性。主訴は背腰部痛と左乳頭のしこり。精査の結果は左乳癌および左腎癌,腎癌肺骨胸膜転移。検討の結果,左乳癌は経過観察とし,腎癌はcT4N0M1-stage Ⅳにより癌化学療法sunitinibを開始した。途中,Grade 3の有害事象の出現を認めた。腎癌がPDとなりtemsirolimusに変更した。この腎癌治療経過のなかで乳癌は腫瘍径の縮小を認めた。sunitinibは血管内皮成長因子などの複数の標的を阻害するチロシンキナーゼ阻害剤である。乳癌についていくつかの報告があるが,未だ従来治療を上回る報告はない。一方mTOR阻害剤であるtemsirolimusは,ホルモン療法の相乗効果が報告されている。またeverolimusでは閉経後転移性乳癌患者を対象としたSERM単独群対SERM+everolimus併用群の比較試験で,clinical benefit,median TTPで併用群が優れており(TAMRAD trial),現在進行中の臨床試験BOLERO-2(exemestane+/-everolimus)でもよい結果が報告されている。everolimusはホルモン感受性乳癌の治療薬として有望である。
目次
Summary
A 43-year-old man complained of back hip pain and of a 2 cm palpable mass of the left breast. The results from a careful examination were left breast cancer, a left renal cancer, and metastases to lung, bone and pleura. As a result of discussion with a urologist, the left breast cancer was followed-up, and the left advanced renal cancer cT4N0M1-stage Ⅳ received chemotherapy by sunitinib. In sunitinib therapy, we recognized some adverse events of Grade 3. The left renal cancer became a progressive-disease. Therefore, we changed chemotherapy to an mTOR inhibitor, temsirolimus. The left renal cancer was long SD-PD by treatment of temsirolimus, and the left male breast cancer was improved. Sunitinib is a tyrosine kinase inhibitor for multi-targets including VEGFR, PDGFR, c-kit et. There are some reports about breast cancer, but there are no results yet superior to those obtained by conventional therapy. On the other hand, a mTOR inhibitor, temsirolimus, was reported to have a synergy effect with hormone therapy for breast cancer. Concerning everolimus, which is one of the mTOR inhibitors, it was reported that results from the SERM+everolimus combination group were superior to those from the SERM alone group for postmenopausal metastatic breast cancer patients in clinical trial(TAMRAD trial). Good results are also being reported now from BOLERO-2(exemestane+/-everolimus), which is undergoing clinical trials. Therefore, everolimus is promising as a therapeutic drug for ER-positive breast cancer.
要旨
症例は43歳,男性。主訴は背腰部痛と左乳頭のしこり。精査の結果は左乳癌および左腎癌,腎癌肺骨胸膜転移。検討の結果,左乳癌は経過観察とし,腎癌はcT4N0M1-stage Ⅳにより癌化学療法sunitinibを開始した。途中,Grade 3の有害事象の出現を認めた。腎癌がPDとなりtemsirolimusに変更した。この腎癌治療経過のなかで乳癌は腫瘍径の縮小を認めた。sunitinibは血管内皮成長因子などの複数の標的を阻害するチロシンキナーゼ阻害剤である。乳癌についていくつかの報告があるが,未だ従来治療を上回る報告はない。一方mTOR阻害剤であるtemsirolimusは,ホルモン療法の相乗効果が報告されている。またeverolimusでは閉経後転移性乳癌患者を対象としたSERM単独群対SERM+everolimus併用群の比較試験で,clinical benefit,median TTPで併用群が優れており(TAMRAD trial),現在進行中の臨床試験BOLERO-2(exemestane+/-everolimus)でもよい結果が報告されている。everolimusはホルモン感受性乳癌の治療薬として有望である。