Long-term complete response in a patient with liver metastases from breast cancer treated with metronomic chemotherapy

• Published in: Tumori 2014-05, Vol.100 (3), p.e79-e82
• Main Authors: Cecconetto, Lorenzo, Casadei Gardini, Andrea, Tenti, Elena, Maltoni, Roberta, Bravaccini, Sara, Oboldi, Devil, Zoli, Wainer, Serra, Patrizia, Donati, Caterina, Sarti, Samanta, Amadori, Dino, Rocca, Andrea
• Format: Article
• Language: English
• Subjects: Administration, Metronomic; Administration, Oral; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - analysis; Carcinoma, Ductal, Breast - drug therapy; Carcinoma, Ductal, Breast - secondary; Cyclophosphamide - administration & dosage; Doxorubicin - administration & dosage; Female; Humans; Immunohistochemistry; Liver Neoplasms - diagnosis; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Maintenance Chemotherapy; Mastectomy, Modified Radical; Methotrexate - administration & dosage; Middle Aged; Neoplasm Staging; Paclitaxel - administration & dosage; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome; Triple Negative Breast Neoplasms - drug therapy; Triple Negative Breast Neoplasms - pathology; Up-Regulation; Vascular Endothelial Growth Factor Receptor-2 - analysis
• ISSN: 2038-2529
• DOI: 10.1700/1578.17238

Preclinical studies have shown that several chemotherapeutic agents at low doses may affect the vascular system. Here we report the case of a patient with long-term cancer control by metronomic chemotherapy. A 62-year-old woman with breast cancer underwent a left mastectomy in July 2007. For a liver metastasis she was given first-line chemotherapy with doxorubicin plus paclitaxel every 21 days. A CT scan after the sixth cycle showed a partial response. It was decided to stop the treatment with doxorubicin and paclitaxel, and start metronomic therapy with cyclophosphamide 50 mg daily orally and methotrexate 2.5 mg twice daily, 2 days a week. After 6 months of this maintenance treatment, CT scan showed a complete response. We examined the expression of vascular endothelial growth factor receptor 2 (VEGFR2) in histological sections of the primary tumor of our patient, finding evidence of overexpression of the receptor. The metronomic treatment is still ongoing, and after 60 months the patient maintains a complete response. This clinical case highlights how suitable metronomic chemotherapy can be used as maintenance therapy, allowing long-term treatment with no significant toxicity. This case suggests that the level of VEGFR2 is predictive of best response to antiangiogenic therapy.