内容紹介
A Case of Estrogen Receptor-Positive Metastatic Breast Cancer in a Postmenopausal Woman Treated with Ethinyl Estradiol
Summary
The patient was 77-year-old woman whose breast cancer had metastasized to the bone and soft tissue 5 years after surgery. Although she had been sequentially treated with endocrine therapies following chemotherapies, new metastatic lesions in the pleura and skin appeared 8 years after recurrence. The biopsied skin tissue showed high positivity for estrogen receptor(ER), was negative for human epidermal growth factor receptor 2(HER2), and had a low Ki-67 labeling index. Following the treatment with exemestane(EXE)for 3 months, ethinyl estradiol(EE2)was administered at 3 mg/day. After 4 months of treatment, the lymph nodes shrunk to 35% of their size and pleural effusion disappeared. The efficacy of EE2 was observed for 10 months. Subsequently, fulvestrant was administered because the skin lesions showed progressive disease. Adverse events such as nausea and general fatigue were observed at the beginning of EE2 therapy. Pigmentation of the nipple and areola and cystic swelling of the cervical canal were observed after a few months. This therapy can be considered to be effective in patients with ER-positive metastatic breast cancer who have been heavily treated with endocrine therapies and chemotherapies.
要旨
患者は77歳,女性。乳癌手術後5年で骨,軟部組織に再発した。内分泌療法,続いて化学療法を逐次投与したが,再発治療開始8年後に癌性胸水,背部皮膚に新病巣を認めた。皮膚生検ではER強陽性,HER2陰性,Ki-67 10%で,exemestane(EXE)(25 mg/day, po)を3か月投与後にethinyl estradiol(EE2)(3 mg/day, po)を開始した。4か月でリンパ節は35%縮小,胸水減少し,奏効と判断した。効果は10か月間継続したが,背部病巣の悪化を認め,fulvestrant(500 mg/body/4 week, im)に変更し,その後10か月間継続している。EE2の副作用として悪心,全身倦怠を投与初期に,その後乳頭,乳輪の色素沈着,子宮頸部嚢胞性腫大を認めた。本療法は高度の薬物療法が行われたER陽性再発乳癌に対して有効であり,新たな治療戦略と考えられる。
目次
Summary
The patient was 77-year-old woman whose breast cancer had metastasized to the bone and soft tissue 5 years after surgery. Although she had been sequentially treated with endocrine therapies following chemotherapies, new metastatic lesions in the pleura and skin appeared 8 years after recurrence. The biopsied skin tissue showed high positivity for estrogen receptor(ER), was negative for human epidermal growth factor receptor 2(HER2), and had a low Ki-67 labeling index. Following the treatment with exemestane(EXE)for 3 months, ethinyl estradiol(EE2)was administered at 3 mg/day. After 4 months of treatment, the lymph nodes shrunk to 35% of their size and pleural effusion disappeared. The efficacy of EE2 was observed for 10 months. Subsequently, fulvestrant was administered because the skin lesions showed progressive disease. Adverse events such as nausea and general fatigue were observed at the beginning of EE2 therapy. Pigmentation of the nipple and areola and cystic swelling of the cervical canal were observed after a few months. This therapy can be considered to be effective in patients with ER-positive metastatic breast cancer who have been heavily treated with endocrine therapies and chemotherapies.
要旨
患者は77歳,女性。乳癌手術後5年で骨,軟部組織に再発した。内分泌療法,続いて化学療法を逐次投与したが,再発治療開始8年後に癌性胸水,背部皮膚に新病巣を認めた。皮膚生検ではER強陽性,HER2陰性,Ki-67 10%で,exemestane(EXE)(25 mg/day, po)を3か月投与後にethinyl estradiol(EE2)(3 mg/day, po)を開始した。4か月でリンパ節は35%縮小,胸水減少し,奏効と判断した。効果は10か月間継続したが,背部病巣の悪化を認め,fulvestrant(500 mg/body/4 week, im)に変更し,その後10か月間継続している。EE2の副作用として悪心,全身倦怠を投与初期に,その後乳頭,乳輪の色素沈着,子宮頸部嚢胞性腫大を認めた。本療法は高度の薬物療法が行われたER陽性再発乳癌に対して有効であり,新たな治療戦略と考えられる。