Antineoplastics

Abstract

Myelotoxicity: case reportA 52-year-old woman developed myelotoxicity during treatment with cyclophosphamide, doxorubicin, carboplatin and paclitaxel for locally-advanced breast cancer (LABC).The woman presented for evaluation of a new onset of palpable breast lesions. Her medical history included renal artery aneurysm treated with covered stents. Subsequent examinations showed triple-negative invasive ductal carcinoma with involvement of axillary lymph node. Based on the examinations, she was diagnosed with LABC. Following consultation with multidisciplinary team, she started receiving neoadjuvant chemotherapy (NAC) with doxorubicin [Adriamycin] and cyclophosphamide scheduled for four cycles followed by carboplatin and paclitaxel scheduled for six cycles [routes and dosages not stated]. However, she developed grade 4 myelotoxicity secondary to neoadjuvant chemotherapy.The woman's treatment cyclophosphamide, doxorubicin, carboplatin and paclitaxel was therefore discontinued after five months. A bilateral breast ultrasonography showed a partial pathological response of neoadjuvant chemotherapy. Thereafter, she was scheduled to undergo axillary lymph-node dissection with fluorescence axillary reverse mapping (ARM). Following injection of fluorescence indocyanine green (ICG), two lymph-nodes draining the ipsilateral upper arm were identified. Thereafter, she underwent axillary lymph-node dissection. Pathological examination confirmed the presence of malignancy in both lymph nodes. Then, right simplex mastectomy followed by placement of a tissue expander was performed. At 1-month follow-up, she was free from distant and loco-regional neoplastic recurrence [outcome of ADR not stated].