Male Breast Cancer Controlled for Years Through Multiple Lines of Targeted and Endocrine Therapy

This breast cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Invasive Ductal Carcinoma
Biomarkers
Initial tumor ER-positive, PR-positive, HER2-positive; later ER-positive, PR-negative, HER2-negative; PIK3CA mutation; germline BRCA1/2 negative
Sex
male
Spread to
bones, pleura, liver
Treatment
surgery, chemotherapy, endocrine therapy, targeted therapy, radiation and palliative care
Outcome
In Memory

Treatment course, step by step

  1. Underwent radical mastectomy with axillary lymph-node dissection in 2007.
  2. Received 6 cycles of docetaxel plus epirubicin, followed by tamoxifen, radiotherapy and 1 year of trastuzumab.
  3. After bone metastases appeared 5 years and 6 months later, received several endocrine and HER2-directed regimens and palliative bone radiation.
  4. Received everolimus plus exemestane with disease control for 28 months.
  5. Later received palbociclib plus fulvestrant with disease control for 25 months.
  6. After progression to bone and liver, he declined further chemotherapy and received best supportive care.

What happened, in summary

A 73-year-old man was diagnosed in 2007 with locally advanced invasive ductal cancer of the right breast after living with a breast lump for several years. Staging found no distant spread, and he underwent radical mastectomy with axillary lymph-node dissection. The tumor was estrogen-receptor positive, progesterone-receptor positive and HER2-positive. He then received 6 cycles of docetaxel plus epirubicin, tamoxifen, radiotherapy and 1 year of trastuzumab.

After a disease-free interval of 5 years and 6 months, bone metastases appeared in 2013. Over the following years he received several lines of endocrine, HER2-directed and bone-targeted treatment. Later testing showed that the metastatic cancer was ER-positive but PR-negative and HER2-negative. Everolimus plus exemestane controlled the disease for 28 months, and palbociclib plus fulvestrant produced another response lasting about 25 months.

By 2020, the cancer had progressed in bone and newly involved the liver. A PIK3CA mutation was identified, but he did not start the proposed alpelisib regimen and declined further chemotherapy. He transitioned to best supportive care and died in January 2021, more than 13 years after his original breast-cancer diagnosis.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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