Stage IV ER/PR-positive mucinous breast cancer: long-term no evidence of disease after surgery, AFTV, radiation, CEF, and endocrine therapy

What happened, in summary

This 52-year-old woman presented with a right breast lump measuring about 4.2 × 3.0 × 4.5 cm. Mammography, ultrasound, aspiration biopsy cytology, CT, and MRI supported a diagnosis of breast carcinoma. Bone scintigraphy also showed strong uptake in the Th7 vertebra, which matched her back pain and corresponded to a 3.0 cm metastatic lesion on MRI and CT. She therefore had Stage IV mucinous breast carcinoma with a solitary bone metastasis rather than node-positive disease; none of 16 tumor-draining lymph nodes contained carcinoma. On 7 August 2006, she underwent right modified radical mastectomy, and pathology confirmed mucinous carcinoma. Because she strongly wanted a tumor-vaccine approach, her team prepared an autologous formalin-fixed tumor vaccine, or AFTV, from her own formalin-fixed and paraffin-embedded tumor tissue. Vaccination began on 27 August 2006 and was given once weekly for 3 weeks. At the same time, she received palliative radiation to the Th7 vertebral metastasis: 36 Gy total, delivered as 3 Gy per day in 12 fractions from 28 August to 12 September. Treatment was uneventful, without reported adverse effects. Starting 24 October 2006, she also received 6 courses of CEF chemotherapy, zoledronic acid, and aromatase inhibitors for hormone receptor-positive disease. Vertebral uptake diminished after 1 year, faded further by December 2009, and stabilized to scar-like background signal by 4 years. More than 6 years after surgery, she remained well with no evidence of metastasis or local recurrence. Her course is notable because a symptomatic bone metastasis became inactive over years while she remained clinically well after multimodality treatment.