What happened, in summary

A 70-year-old woman developed weakness, swallowing difficulty, characteristic skin rashes and redness involving her right breast. Breast tissue showed invasive ductal carcinoma that was estrogen-receptor positive, progesterone-receptor positive and HER2-positive. Her physicians also diagnosed dermatomyositis, an inflammatory condition that appeared to track closely with the cancer.

Because the breast tumor was not initially operable, she began epirubicin plus cyclophosphamide. After the first few cycles, the breast mass and redness shrank markedly, while her muscle weakness, hoarseness, swallowing difficulty and skin symptoms also improved. The response made surgery possible, and examination of the removed breast tissue showed a pathologic complete response.

She then started letrozole. Joint pain and muscle symptoms led to changes first to exemestane and then to toremifene, but persistent side effects eventually led her to stop endocrine therapy after 1 year and 8 months. Later, when her skin and muscle symptoms worsened again, imaging was performed because of concern for breast-cancer recurrence. CT, breast ultrasound and bone scans found no recurrence. Further evaluation instead identified a new sigmoid-colon cancer, treated as a separate cancer journey.