Overcoming Stage IV Male Breast Cancer with Innovative Treatment

In 2019, a 71-year-old male presented at Xiangya Hospital with a four-year history of swelling in the right axillary lymph nodes. The condition had progressed to skin ulceration, prompting immediate diagnostic imaging. An ultrasound revealed multiple solid nodules, and a biopsy confirmed poorly differentiated adenocarcinoma, strongly suggesting breast cancer. Immunohistochemical tests supported this diagnosis, revealing HER2 positivity (3+) and a Ki-67 index of 40%.

Further imaging, including CT and PET-CT, revealed extensive metastases in lymph nodes, the mediastinum, and the lungs, leading to a final diagnosis of metastatic breast cancer (MOBC), clinical stage IV (cTxN3M1). Genetic testing showed no BRCA1/2 mutations.

The patient began systemic therapy with a regimen that included paclitaxel liposome, capecitabine, and trastuzumab. Over the course of eight cycles, tumor shrinkage and regression of skin nodules were observed. Subsequent imaging confirmed a partial response, though axillary lymph nodes remained adherent to vital structures, making surgery unfeasible at the time.

In July 2020, treatment was adjusted to a combination of dual-targeted therapy with trastuzumab and pertuzumab alongside capecitabine chemotherapy. By November 2020, imaging confirmed further tumor reduction, allowing for a successful axillary lymph node dissection (ALND). Postoperative analysis revealed metastasis in 7 out of 21 lymph nodes but also significant tumor regression.

Following surgery, the patient continued dual-targeted therapy with capecitabine maintenance treatment for several months. In April-May 2021, radiotherapy was administered to the right breast and tumor bed using intensity-modulated radiation therapy (IMRT) to target any residual disease.

The treatment was highly effective. As of 2024, follow-ups show no evidence of disease progression. The patient achieved disease control and maintained a good quality of life despite the initial stage IV diagnosis. This journey highlights the power of advanced oncology treatments and the resilience of patients in the face of a difficult diagnosis.