Documentation of Complete Response in Metastatic Breast Cancer to Liver and Bone Achieved with Trastuzumab and Pegylated Liposomal Doxorubicin

We present a case report of a complete response to a combination of trastuzumab and pegylated liposomal doxorubicin in a female patient with recurrent metastatic HER-2 positive breast cancer after anthracycline-based adjuvant primary chemotherapy. To our knowledge this sequence of events has not previously been reported. In September 2003, after routine mammographic detection, this 59-year-old business executive mother of two underwent right mastectomy and axillary node dissection with immediate reconstruction. Pathologic diagnosis included a T1N0M0 poorly differentiated infiltrating ductal carcinoma and further characterized by high proliferative fraction, negative hormone receptors, 3+ Her2 expression by immunohistochemistry, and 8-fold amplification of Her2 by FISH. Entry into Intergroup Study N9831 (1) was precluded by presumed pressure related brachial paresis during her postoperative recovery. Her adjuvant chemotherapy consisted of four cycles of doxorubicin (60 mg/m 2) + cyclophosphamide (600 mg/m 2) on a dose-dense (biweekly) schedule with G-CSF, followed by 7 doses of paclitaxel (100 mg/m 2) every 10 to 11 days (without growth factors). She remained well for one and a half years, when lumbo-sacral and lower thoracic pain while exercising prompted a bone scan showing multiple lesions. PET/CT (Fig. 1a) confirmed bone scan findings and in addition showed liver involvement.

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