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Breast cancer is the largest malignant tumor in my country, and triple-negative breast cancer is the subtype with the worst prognosis, accounting for 15-20% of all breast cancers.
It is not sensitive to common endocrine therapy and targeted therapy, and current treatments are relatively limited.
Although scientists have studied the gene mutation spectrum of triple-negative breast cancer, there are relatively few reports of targeted therapy based on gene mutations.
However, if you can find driver gene mutations with targeted drugs, you might try targeted therapy.
Today, the editor will share with you a case of advanced triple-negative breast cancer patients with remission after targeted therapy.
After repeated defeats, treatment troubles.
A 31-year-old white woman found a lump in her right breast.
After a hospital examination, she was diagnosed with triple-negative breast cancer and had lymph node metastasis.
Triple-negative breast cancer (TNBC) refers to breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor-2 (HER) gene, clinically It is generally determined by immunohistochemistry.
This patient does not smoke and does not drink much alcohol, but the patient's mother had breast cancer when she was 50 years old, so she has a family history, which may be a genetic factor, but genetic testing did not find BRCA1 and BRCA2 gene mutations.
Surgery was the best treatment at the time.
The doctor first performed neoadjuvant chemotherapy on the patient, that is, carboplatin, paclitaxel, and liposomal adriamycin were used to reduce the tumor lesions, then the right mastectomy was performed and the axillary lymph nodes were cleaned.
The subsequent histological examination found that there were residues, for which the patient received radiotherapy and adjuvant chemotherapy.
Cyclophosphamide, methotrexate, and 5-fluorouracil used in chemotherapy regimens.
Due to a strong adverse reaction, methotrexate was discontinued one month later, and the patient continued oral cyclophosphamide and capitabine for treatment.
Two years after the operation, the patient was re-examined and found suspicious lesions in the right lung, which was confirmed by needle biopsy as a metastasis of triple-negative breast cancer.
At this time, the surgery was meaningless, and the patient was treated with palliative chemotherapy.
The chemotherapy regimen was carboplatin combined with paclitaxel.
After three months of treatment, the lesion was found to shrink.
The doctor used irreversible electroporation (Nanoknife) for the residual lung metastases in the right lung.
At the same time, he continued to use paclitaxel combined with carboplatin chemotherapy.
Unfortunately, after such a arduous treatment process, the tumor has not shrunk.
Re-examination three months later, the right lung reappeared with metastases.
During second-line chemotherapy, the patient developed severe diarrhea.
Continuous treatment fails to achieve results, and the patient is physically and mentally exhausted.
Unconventional targeted drugs, the effect is amazing.
This patient is very young and the existing treatment measures are not effective.
Is there any other way? Clinical experts take a sample of tumor tissue for genetic testing (FoundationOne CDx) to see if the driver gene mutation is used.
The results confirmed the presence of the V600E mutation of the BRAF gene, and the cross-indication drug Vemurafenib was recommended.
When a gene mutation of a targeted drug is found in a tumor, and the targeted drug is temporarily not approved for the treatment of the tumor, if the drug is to be used at this time, it is a cross-indication drug.
Verofenib is a targeted drug for the BRAF gene V600E mutation site, but it has not been indicated for triple-negative breast cancer.
In clinical practice, verofenib is often not used for treatment, and it needs to be confirmed by clinical trials.
This medicine is also effective in breast cancer.
Due to the patient's special circumstances, after careful discussion with the patient by the clinician, the patient signed an informed consent form in May 2019, and received oral verofenib twice a day for treatment with a dose of 720 mg each time.
However, cross-indication drugs are not eligible for medical insurance abroad, and patients must pay for their own expensive medical expenses.
Figure 1.
Symptoms recorded on the phone during the patient's treatment with verofinib.
Fortunately, fate finally opened another window for her.
The patient's use of verofinib was very effective, except for slight nausea and rash during the initial use.
And hand-foot syndrome, lung metastases achieved partial remission after three months of treatment.
So far, she has been using Verofenib for 19 months, and the lung metastases have been in a stable state, and the patient's body sensation and quality of life have also been better alleviated.
Figure 2.
Cross-indication medication significantly improves lung metastases.
Cross-indication medication brings us thinking.
Although the concept of precision medicine has been widely known, clinicians generally do not consider cross-indication medication to be the first choice.
But if other therapies fail, you can consider genetic testing to see if there are driver gene mutations.
Trying targeted drugs may be useful.
The frequency of BRAF V600E mutation in triple-negative breast cancer is 2-3%.
If it is determined that there is a V600E mutation in the BRAF gene, you can consider using verofenib under the guidance of a doctor.
Readers may have questions, why not use PD-1 inhibitors or anti-angiogenesis targeted drugs? Anti-angiogenesis targeted drugs do not target tumor-driven gene mutations, and it is difficult to achieve sustained remission for more than 19 months.
For this patient, even the use of PD-1 inhibitors may not have such a good effect.
For patients with triple-negative breast cancer, the researchers suggest that genetic testing can be performed if possible to determine the feasibility of benefiting from potential targeted drugs.
Pay attention to the degree of cancer and learn about the latest information on anti-cancer and anti-cancer.
References Magdalena Pircher, et al.
, Response to Vemurafenib in Metastatic Triple-Negative Breast Cancer Harbouring a BRAF V600E Mutation: A Case Report and Electronically Captured Patient-Reported Outcome, Case Rep Oncol 2021;14:616–621 Click below to learn More clinical trial projects
It is not sensitive to common endocrine therapy and targeted therapy, and current treatments are relatively limited.
Although scientists have studied the gene mutation spectrum of triple-negative breast cancer, there are relatively few reports of targeted therapy based on gene mutations.
However, if you can find driver gene mutations with targeted drugs, you might try targeted therapy.
Today, the editor will share with you a case of advanced triple-negative breast cancer patients with remission after targeted therapy.
After repeated defeats, treatment troubles.
A 31-year-old white woman found a lump in her right breast.
After a hospital examination, she was diagnosed with triple-negative breast cancer and had lymph node metastasis.
Triple-negative breast cancer (TNBC) refers to breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and epidermal growth factor receptor-2 (HER) gene, clinically It is generally determined by immunohistochemistry.
This patient does not smoke and does not drink much alcohol, but the patient's mother had breast cancer when she was 50 years old, so she has a family history, which may be a genetic factor, but genetic testing did not find BRCA1 and BRCA2 gene mutations.
Surgery was the best treatment at the time.
The doctor first performed neoadjuvant chemotherapy on the patient, that is, carboplatin, paclitaxel, and liposomal adriamycin were used to reduce the tumor lesions, then the right mastectomy was performed and the axillary lymph nodes were cleaned.
The subsequent histological examination found that there were residues, for which the patient received radiotherapy and adjuvant chemotherapy.
Cyclophosphamide, methotrexate, and 5-fluorouracil used in chemotherapy regimens.
Due to a strong adverse reaction, methotrexate was discontinued one month later, and the patient continued oral cyclophosphamide and capitabine for treatment.
Two years after the operation, the patient was re-examined and found suspicious lesions in the right lung, which was confirmed by needle biopsy as a metastasis of triple-negative breast cancer.
At this time, the surgery was meaningless, and the patient was treated with palliative chemotherapy.
The chemotherapy regimen was carboplatin combined with paclitaxel.
After three months of treatment, the lesion was found to shrink.
The doctor used irreversible electroporation (Nanoknife) for the residual lung metastases in the right lung.
At the same time, he continued to use paclitaxel combined with carboplatin chemotherapy.
Unfortunately, after such a arduous treatment process, the tumor has not shrunk.
Re-examination three months later, the right lung reappeared with metastases.
During second-line chemotherapy, the patient developed severe diarrhea.
Continuous treatment fails to achieve results, and the patient is physically and mentally exhausted.
Unconventional targeted drugs, the effect is amazing.
This patient is very young and the existing treatment measures are not effective.
Is there any other way? Clinical experts take a sample of tumor tissue for genetic testing (FoundationOne CDx) to see if the driver gene mutation is used.
The results confirmed the presence of the V600E mutation of the BRAF gene, and the cross-indication drug Vemurafenib was recommended.
When a gene mutation of a targeted drug is found in a tumor, and the targeted drug is temporarily not approved for the treatment of the tumor, if the drug is to be used at this time, it is a cross-indication drug.
Verofenib is a targeted drug for the BRAF gene V600E mutation site, but it has not been indicated for triple-negative breast cancer.
In clinical practice, verofenib is often not used for treatment, and it needs to be confirmed by clinical trials.
This medicine is also effective in breast cancer.
Due to the patient's special circumstances, after careful discussion with the patient by the clinician, the patient signed an informed consent form in May 2019, and received oral verofenib twice a day for treatment with a dose of 720 mg each time.
However, cross-indication drugs are not eligible for medical insurance abroad, and patients must pay for their own expensive medical expenses.
Figure 1.
Symptoms recorded on the phone during the patient's treatment with verofinib.
Fortunately, fate finally opened another window for her.
The patient's use of verofinib was very effective, except for slight nausea and rash during the initial use.
And hand-foot syndrome, lung metastases achieved partial remission after three months of treatment.
So far, she has been using Verofenib for 19 months, and the lung metastases have been in a stable state, and the patient's body sensation and quality of life have also been better alleviated.
Figure 2.
Cross-indication medication significantly improves lung metastases.
Cross-indication medication brings us thinking.
Although the concept of precision medicine has been widely known, clinicians generally do not consider cross-indication medication to be the first choice.
But if other therapies fail, you can consider genetic testing to see if there are driver gene mutations.
Trying targeted drugs may be useful.
The frequency of BRAF V600E mutation in triple-negative breast cancer is 2-3%.
If it is determined that there is a V600E mutation in the BRAF gene, you can consider using verofenib under the guidance of a doctor.
Readers may have questions, why not use PD-1 inhibitors or anti-angiogenesis targeted drugs? Anti-angiogenesis targeted drugs do not target tumor-driven gene mutations, and it is difficult to achieve sustained remission for more than 19 months.
For this patient, even the use of PD-1 inhibitors may not have such a good effect.
For patients with triple-negative breast cancer, the researchers suggest that genetic testing can be performed if possible to determine the feasibility of benefiting from potential targeted drugs.
Pay attention to the degree of cancer and learn about the latest information on anti-cancer and anti-cancer.
References Magdalena Pircher, et al.
, Response to Vemurafenib in Metastatic Triple-Negative Breast Cancer Harbouring a BRAF V600E Mutation: A Case Report and Electronically Captured Patient-Reported Outcome, Case Rep Oncol 2021;14:616–621 Click below to learn More clinical trial projects
