術前術後の化学療法併用により,局所の病理学的CRと転移巣の臨床的CRを得たHER2陽性転移性乳癌の一例

A 56-year-old woman with Stage IV right breast cancer (DCE, T4cN3CMI (lymph nodes, liver and bone), ER (-), PgR(-), HER2 (3+)) underwent treatment with paclitaxel and trastuzumab. After chemotherapy for 4 months, primary breast tumor and lymph nodes turned out to be nonpalpable. Liver metastases were decreased remarkably. Right modified radical mastectomy (Auchincloss method) was performed, and no breast cancer cells were recognized in the resected specimen, breast and lymph nodes. The pathological effect resulted in complete response. Postoperative chemotherapy with doxorubicin and cyclophosphamide (AC) were performed for 4 courses. After AC therapy, treatments with trastuzumab, capecitabine or pamidronate disodium were continued. Liver and bone metastases disappeared. After 10 months from operation, brain metastases were proved and disappeared by cranial irradiation.
　症例は56才女性,IV期乳癌(右DCE,T4cN3cM1(リンパ節転移,肝転移,骨転移),ER(-),PgR(-),HER2(3+))に対し,paclitaxe1とtrastuzumabを併用投与した。4ヶ月後原発巣とリンパ節は触知不能となり,肝転移巣は著明に縮小し,非定型的右乳房切除術を行なった。切除された乳腺,リンパ節内に腫瘍細胞は見出せず,術前化学療法の効果はgrade3と判定された。術後はAC療法(doxorubicin+cyclophosphamide)後,trastuzumab,capecitabine,pamidronatedisodium
投与を続け,肝転移骨転移は消失した。術後!0ヶ月で脳転移をきたしたが,全脳照射で転移巣は消失した。