Lasting remission following multimodal treatment in a patient with metastatic breast cancer.

Abstract

We report on a lasting remission from multimodal treatment in a patient with hepatic metastasized breast cancer. After surgical removal of a singular hepatic metastasis, the patient underwent leukapheresis of peripheral blood mononuclear cell (PBMCs). For induction chemotherapy, the patient received 2 cycles of epirubicin and paclitaxel (ET). After 1 cycle of epirubicin and ifosfamide (EI), peripheral blood stem cells were harvested. After a final cycle of ET, the patient underwent high-dose chemotherapy (HDCT; thiotepa 600 mg/m/melphalan 180 mg/m) and autologous stem cell transplantation. Once reconstitution was achieved, PBMCs were reinfused followed by i.v. application of a trifunctional antibody (TrAb) with specificities anti-EpCAMxanti-CD3. TrAbs are able to simultaneously bind tumor cells, T cells, and additionally FcgammaR type I and III+accessory cells via their Fc region. Side-effects during treatment were hematotoxicity, mucositis and gastrointestinal toxicity. TrAb treatment resulted in intermittent fever, chills, elevated liver enzymes, systemic inflammatory response syndrome and pulmonary leakage. With a follow-up period of more than 8 years the patient is still in remission (96+months). This case suggests the feasibility and efficacy of combining surgery, standard and HDCT, and subsequent immunotherapy in metastatic breast cancer. Further investigation of this approach is indicated in a subgroup of patients with oligometastatic breast cancer.

• Authors: H J Stemmler, H Menzel, C Salat, H Lindhofer, S Kahlert, V Heinemann, H J Kolb
• Journal: Anti-cancer drugs (Anticancer Drugs) Vol. 16 Issue 10 Pg. 1135-7 (Nov 2005) ISSN: 0959-4973 [Print] England
• PMID: 16222157 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies
• Antigens, Neoplasm
• CD3 Complex
• Cell Adhesion Molecules
• EPCAM protein, human
• Epithelial Cell Adhesion Molecule
• Epirubicin
• Thiotepa
• Paclitaxel

Topics

• Adult
• Antibodies (therapeutic use)
• Antigens, Neoplasm (immunology)
• Breast Neoplasms (drug therapy, pathology, therapy)
• CD3 Complex (immunology)
• Cell Adhesion Molecules (immunology)
• Combined Modality Therapy (adverse effects)
• Epirubicin (therapeutic use)
• Epithelial Cell Adhesion Molecule
• Female
• Humans
• Leukapheresis
• Liver Neoplasms (secondary)
• Paclitaxel (therapeutic use)
• Remission Induction
• Thiotepa (therapeutic use)
• Treatment Outcome