S-1 plus temozolomide as second-line treatment for neuroendocrine carcinoma of the breast: A case report

Abstract

BACKGROUND Neuroendocrine carcinoma of the breast (NECB) is a rare type of malignant tumor. Due to the rarity of NECB, the relevant literature mostly comprises case reports. Available data on treatment options for NECB are very limited. CASE SUMMARY A 62-year-old woman presented to our hospital in October 2016 for intermittent vomiting and diarrhea and masses in the liver found on abdominal computed tomography (CT) imaging. She was diagnosed in July 2012 with neuroendocrine carcinoma of the right breast in local hospital. The patient initially presented with a painful lesion of the right breast. She then undergone surgical resection and adjuvant chemotherapy with pirarubicin and paclitaxel for four cycles as well as endocrine therapy. She was regularly followed every 3 mo after surgery. Enhanced abdominal CT imaging at our hospital revealed multiple suspicious masses in the liver with the largest lesion measuring 8.4 cm × 6.3 cm. Chest CT revealed masses in the anterior chest wall and lung. Core needle biopsy of the lesion revealed liver metastases of NECB. A bone scan showed right second anterior rib metastases. Upper endoscopy and colonoscopy did not provide any evidence of another possible primary tumor. She stopped receiving endocrine therapy and then received etoposide and cisplatin (EP) chemotherapy as a first-line treatment regimen for six cycles at our hospital after liver, bone, and lung metastases. On October 2017, the chemotherapy regimen was changed to S-1 (40 mg twice daily, days 1-14) combined with temozolomide (200 mg once daily, days 10-14) (STEM) every 21 d as a second-line treatment regimen due to disease progression. Progression-free survival (PFS) and adverse effects after treatment were analyzed, and the efficacy of the STEM regimen was assessed using RECIST version 1.1. This patient achieved a partial response after using the STEM regimen, with a PFS of 23 mo. Adverse effects included only grade 1 digestive tract reactions with no need for a reduction in chemotherapy. CONCLUSION This case report suggests that the STEM regimen may be effective and well tolerated as the second-line treatment for advanced NECB. STEM is still highly effective in patients who show disease progression with the EP regimen. More evidence is needed to prove the validity of STEM.

Primary neuroendocrine carcinoma of the breast with leptomeninges metastasis: A case report and literature review

“…A search of the literature published in PubMed V R from 1980 to 2021 using the terms ("neuroendocrine cancer of breast" or "small cell breast cancer" or "oat cell carcinoma of the breast") and ("advanced" or "metastatic") identified 12 case reports related to metastatic NEBC. [5][6][7][8][9][10][11][12][13][14][15][16] The following data were extracted from each article: first author name, year of publication, patient sex, age, tumour size, family history of breast cancer, status of ER, PR and HER2, Ki-67 index, metastatic sites, disease-free survival, overall survival and treatment options (Table 2). NECB is a rare breast cancer and the median age of onset is 63 years old.…”

“…16 In the literature reviewed, EP and EC were the most frequently used formulas for first-line chemotherapy. 10,11,14,16 Moreover, when metastatic disease is diagnosed, the treatment strategy should be individualized depending on the general conditions and comorbidities of the patient, the extent and aggressiveness of the disease, and the biological features of the tumour. 36 The current case was diagnosed with LM, which is a type of aggressive and malignant metastasis of NECB, with a reported overall survival of 4-6 weeks.…”

“…NECB is a rare breast cancer and the median age of onset is 63 years old. 17 Of the nine articles retrieved that presented ER expression, 6,7,9–14,16 seven of them 6,7,9–13 were negative and one patient overexpressed HER2. 12 In terms of metastatic sites, the most common metastatic sites of NECB were the liver (seven of 12 patients; 58.3%), bones (six of 12 patients; 50.0%), lung, pancreas, soft tissues and brain (one of 12 patients; 8.3%), but few LM were reported.…”

“…Review of published literature related to advanced neuroendocrine cancer of the breast [5][6][7][8][9][10][11][12][13][14][15][16]. …”