[Preoperative therapy using trastuzumab and weekly paclitaxel in a stage IIIB inoperable locally advanced HER2- positive breast cancer with complete pathologic response].

A 63-year-old woman had a 12 cm tumor on her right breast with broad skin redness, satellite lesions and 8 cm ipsilateral lymph nodes swelling(T4bN2aM0, Stage IIIB). Core needle biopsy and immunohistochemistry of breast tumor showed invasive ductal carcinoma with negative hormone receptor(ER-, PgR-)and overexpression of HER2 (HercepTest 3+). She was treated with weekly paclitaxel(80 mg/m(2), 4 administrations with a week rest)and a com- bination with weekly trastuzumab(initially 4 mg/kg followed by 2 mg/kg every week, totally 11 administrations). After 3courses of administration, the breast tumor, skin redness and axillary swelling were completely disappeared(clinical complete response), then mastectomy with axillary dissection was performed. Histopathology of the breast and lymph nodes showed complete disappear of invasive cancer cells with only 2x1 mm residue of ductal component(pCR, grade 3, DC+). We conclude that the combination of weekly paclitaxel and trastuzumab is a promising neoadjuvant therapy regimen for HER2 positive, ER-negative breast cancer.

[Preoperative therapy with trastuzumab and paclitaxel in a stage IV advanced breast cancer with complete pathologic response].

A 53-year-old woman had a 105x100 mm tumor on her right breast with a 55x36 mm-sized bleeding ulcer of the skin and ipsilateral axillary and cervical lymph nodes swelling (T4bN3cM1, Stage IV). Core needle biopsy and immunohistochemistry of breast tumor showed invasive ductal carcinoma with negative hormone receptor (ER-, PgR-) and overexpression of HER 2 (Hercep Test score 3+). She was treated with weekly trastuzumab (initially 4 mg/kg followed by 2 mg/kg every week), and a combination of tri-weekly paclitaxel (175 mg/m(2), 6 courses). After 3 courses of administration, the breast tumor subsided, the ulcer became flat, and axillary and cervical nodes completely disappeared. Clinical CR was obtained after 6 courses of treatment, and mastectomy with axillary clearance was then performed. Histopathology of the breast and lymph nodes showed complete disappearance of cancer cells (pCR, Grade 3+3 (d) +3 (n)). The combination of trastuzumab and paclitaxel is a promising regimen for HER 2 positive advanced breast cancer.

[A case of inflammatory breast cancer achieving pathological complete response by primary systemic therapy with CEF (cyclophosphamide, epirubicin, 5-fluorouracil) followed by docetaxel].

A 48-year-old woman noticed her right breast swelling since a few weeks earlier. Rigidity in the AC area, hotness, swelling and peau d'orange appearance of the right whole breast were recognized. She was diagnosed as inflammatory breast cancer clinically and invasive ductal carcinoma with lymphatic invasion pathologically. The patient underwent primary systemic therapy with 4 cycles of CEF (cyclophosphamide 500 mg/m(2), epirubicin 100 mg/m(2), 5-fluorouracil 500 mg/m(2)) followed by 4 cycles of docetaxel (70 mg/m(2)). The effect of chemotherapy showed a partial response evaluated by mammography and ultrasonography, and complete response by MRI before surgery. Right mastectomy with level II lymph node dissection was performed. Pathologically, complete response was confirmed (pCR). Although IBC has been known for its poor outcome, this case suggests IBC will show a better prognosis by chemotherapy such as CEF followed by docetaxel.

[Markedly effective regimen using bi-weekly trastuzumab and paclitaxel in an advanced breast cancer with multiple liver metastases].

A 69-year-old woman had a 7 x 6 cm tumor on her left breast with ipsilateral axillary lymph node swelling and multiple liver metastases as detected on CT scan (T 3 N 2 M 1 b, Stage IV). Core needle biopsy and immunohistochemistry of breast tumor showed invasive ductal carcinoma with negative hormone receptor and overexpression of HER 2. After a treatment failure of 3 months weekly trastuzumab monotherapy, a combination of bi-weekly trastuzumab and paclitaxel (weekly 6, bi-weekly 9 courses), was given. Tumor markers became negative 4 months later, and multiple liver nodules, breast tumor and axillary nodes completely disappeared 9 months later. Breast surgery was avoided, and CR was maintained more than 8 months only with bi-weekly trastuzumab. From the standpoint of the patient's convenience,a bi-weekly schedule of trastuzumab and paclitaxel could be a promising treatment choice for metastatic breast cancer.

[Neoadjuvant endocrine therapy with anastrozole significantly downstaged an elderly breast cancer woman with locally-advanced breast cancer which became operable].

A 73-year-old postmenopausal woman had a 13 cm-sized huge tumor in her left breast with an extensive purple skin color change. She had sternal destruction, axillary and supraclavicular lymph node metastases (T4bN3M1, Stage IV). Core needle biopsy showed invasive ductal carcinoma with positive hormone receptor (ER+++, PgR+++). She was treated with 1 mg per day of anastrozole. The tumor decreased in size gradually and became operable after 7.5 months of the anastrozole monotherapy. She underwent mastectomy and axillary node clearance. The resected specimen showed a 3.5 cm sized tumor with significant fibrosis and scanty viable tumor cells. We concluded that neoadjuvant therapy with anastrozole is a good choice for receptor-positive postmenopausal breast cancer, especially for elderly or poor risk women.

[Two cases of breast cancer markedly responded to neoadjuvant chemoendocrine therapy (2 cycles of CMF and tamoxifen, pCR and near pCR)].

Case 1 is a 38-year-old woman with a 6 cm tumor in her right breast. After incisional biopsy she received 2 cycles of CMF and tamoxifen in order to effect down staging. The tumor markedly decreased in size. She next underwent breast conserving surgery. Histopathologically, malignant cells completely disappeared (pCR). Case 2 is a 34-year-old woman with a 5.5 cm tumor in her left breast. After incisional biopsy she received the same regimen as in case 1. The tumor diminished significantly in size, and she underwent breast conserving surgery. Histopathologically, only a few fragments of degenerated tumor cells remained. Case 1 was hormone receptor positive, while case 2 was negative. The remarkable responsiveness (pCR and near pCR) to 2 cycles of CMF combined with tamoxifen was interesting. From these results we conclude that the CMF regimen is an useful neoadjuvant chemotherapy alternative to avoid alopecia and GI tract side effects.