内容紹介
Prolonged Remission Achieved by Using Bevacizumab plus Paclitaxel Therapy Combined with Sequential Radiotherapy for a Rapidly Growing Chest Wall Recurrence of Triple Negative Breast Cancer―A Case Report
Summary
A 73-year-old woman, who was diagnosed with right triple negative breast cancer(cT1cN1M0, stageⅠ)and underwent right modified radical mastectomy with axillary lymph node dissection, showed recurrent disease in the right parasternal lymph node 4 years after the operation. Computed tomography(CT)revealed rapid growth of the tumor along with pain, accompanied by the destruction of the sternal bone. Five cycles of bevacizumab plus paclitaxel(BEV+wPTX)treatment(10 mg/kg of bevacizumab on days 1 and 15 plus 90 mg/m2 of paclitaxel on days 1, 8, and 15 every 4 weeks)achieved remarkable tumor regression. Parasternal irradiation(30 Gy/15 Fr)followed by oral capecitabine treatment(600 mg b. i. d; 3 week-administration followed by a week of rest)as maintenance therapy showed complete tumor regression and helped to achieve good quality of life(QOL)without any unfavorable symptoms at the 2-year follow-up, although the estimated progression free survival of this treatment is about 6 months. As BEV+wPTX had a high response rate for recurrent breast cancer, its combination with sequential radiotherapy could provide a favorable local control rate and good QOL for patients with rapidly growing, solitary, recurrent breast cancers.
要旨
症例は73歳,女性。左トリプルネガティブ乳癌[cT1c(2 cm)N0M0,stageⅠ]の診断で左乳房切除術,腋窩リンパ節郭清術を施行したが,術後4年目に傍胸骨リンパ節に再発を認めた。腫瘍は有痛性で,CTにて胸骨破壊像を伴い急速な増大を認めた。bevacizumab+weekly paclitaxel(BEV+wPTX)療法(4週毎,day 1,15にbevacizumab 10 mg/kg,day 1,8,15にpaclitaxel 90 mg/m2を投与)を5コース施行したところ著効を得た。傍胸骨領域に対する放射線治療(30 Gy/15 Fr)施行後にcapecitabine(600 mg,1日2回)内服にて治療を継続。同療法の無増悪生存期間は6か月程度であるところ,内服開始後2年が経過した現在も腫瘍の寛解と良好なQOLを維持している。高い奏効率を有するBEV+wPTXを逐次的な放射線療法と組み合わせることで,急速に進行する孤発性再発病変の長期制御と患者QOLの維持が可能になる症例が存在することが示唆された。
目次
Summary
A 73-year-old woman, who was diagnosed with right triple negative breast cancer(cT1cN1M0, stageⅠ)and underwent right modified radical mastectomy with axillary lymph node dissection, showed recurrent disease in the right parasternal lymph node 4 years after the operation. Computed tomography(CT)revealed rapid growth of the tumor along with pain, accompanied by the destruction of the sternal bone. Five cycles of bevacizumab plus paclitaxel(BEV+wPTX)treatment(10 mg/kg of bevacizumab on days 1 and 15 plus 90 mg/m2 of paclitaxel on days 1, 8, and 15 every 4 weeks)achieved remarkable tumor regression. Parasternal irradiation(30 Gy/15 Fr)followed by oral capecitabine treatment(600 mg b. i. d; 3 week-administration followed by a week of rest)as maintenance therapy showed complete tumor regression and helped to achieve good quality of life(QOL)without any unfavorable symptoms at the 2-year follow-up, although the estimated progression free survival of this treatment is about 6 months. As BEV+wPTX had a high response rate for recurrent breast cancer, its combination with sequential radiotherapy could provide a favorable local control rate and good QOL for patients with rapidly growing, solitary, recurrent breast cancers.
要旨
症例は73歳,女性。左トリプルネガティブ乳癌[cT1c(2 cm)N0M0,stageⅠ]の診断で左乳房切除術,腋窩リンパ節郭清術を施行したが,術後4年目に傍胸骨リンパ節に再発を認めた。腫瘍は有痛性で,CTにて胸骨破壊像を伴い急速な増大を認めた。bevacizumab+weekly paclitaxel(BEV+wPTX)療法(4週毎,day 1,15にbevacizumab 10 mg/kg,day 1,8,15にpaclitaxel 90 mg/m2を投与)を5コース施行したところ著効を得た。傍胸骨領域に対する放射線治療(30 Gy/15 Fr)施行後にcapecitabine(600 mg,1日2回)内服にて治療を継続。同療法の無増悪生存期間は6か月程度であるところ,内服開始後2年が経過した現在も腫瘍の寛解と良好なQOLを維持している。高い奏効率を有するBEV+wPTXを逐次的な放射線療法と組み合わせることで,急速に進行する孤発性再発病変の長期制御と患者QOLの維持が可能になる症例が存在することが示唆された。