scholarly journals Disseminated Carcinomatosis of the Bone Marrow from Occult Breast Cancer Responding to a Sequence of Endocrine Therapy

2020 ◽  
Vol 13 (1) ◽  
pp. 193-199 ◽  
Author(s):  
Takeshi Yamaguchi ◽  
Mariko Masumoto ◽  
Urara Sakurai ◽  
Minoru Nakane
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Endocrine Therapy ◽  
Bone Marrow Involvement ◽  
Receptor Expression ◽  
Small Cells ◽  
Bone Lesions ◽  
Occult Breast Cancer ◽  
Platelet Counts ◽  
Normal Ranges

Patients with cancer of unknown primary (CUP) are generally treated with chemotherapy. Bone marrow involvement suggests an advanced stage, and CUP with disseminated carcinomatosis of the bone marrow (DCBM) appears to have a dismal prognosis. However, our case of CUP with DCBM was successfully treated with a sequence of endocrine therapy over a long period. A woman presenting with low back pain was found to have multiple bone metastasis without an identifiable primary tumor on imaging studies. Blood tests revealed anemia and thrombocytopenia. A bone marrow biopsy was performed and showed relatively uniform small cells, strongly positive for estrogen receptor and progesterone receptor expression. We considered chemotherapy to be risky due to bicytopenia and an aromatase inhibitor, letrozole, was initiated. The patient’s symptoms and laboratory findings gradually improved and bone lesions almost disappeared on FDG-PET/CT after 1 year of treatment. After 2 years on letrozole, hemoglobin levels and platelet counts had been gradually decreasing. Although she had no symptoms and no significant changes were observed on a CT scan, disease progression was highly likely. Thus, second-line treatment with fulvestrant and palbociclib was commenced, and hemoglobin levels and platelet counts were restored to within the normal ranges. She currently continues to receive fulvestrant and palbociclib over a year later. CUP complicated with DCBM might be metastatic occult breast cancer, and endocrine therapy can be a valuable treatment option if tumors express hormone receptors.

scholarly journals Significance of the Genomic Landscape of a De Novo Endocrine-Resistant Metastatic Hormone Receptor–Positive Breast Cancer

2020 ◽  
Vol 14 ◽  
pp. 117822342097638
Author(s):  
Maithreyi Sarma ◽  
Yara Abdou ◽  
Ajay Dhakal ◽  
Shipra Gandhi
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Endocrine Therapy ◽  
Hormone Receptor ◽  
De Novo ◽  
Bone Marrow Involvement ◽  
Genomic Alterations ◽  
Hormone Receptor Positive ◽  
Positive Breast Cancer

Endocrine therapy with or without CDK4/6 inhibitors is the most commonly used frontline treatment option for metastatic hormone receptor–positive breast cancer. Approximately, 25% to 30% of women may have resistance to endocrine therapy, especially in the setting of certain genomic mutations in the tumor. This prompts the need to identify those patients who may benefit from frontline chemotherapy over endocrine therapy. Here, we present a case of a patient who presented with a de novo metastatic hormone receptor–positive breast cancer with visceral involvement (including bone marrow) as well as multiple somatic genomic alterations. The patient was treated with upfront chemotherapy, resulting in clinical and radiographic response, but rapidly progressed when she was transitioned to hormonal therapy. This report focuses on the role of upfront chemotherapy in the setting of visceral crisis including bone marrow involvement, the role of genomic alterations in contributing to endocrine resistance, and the need for biomarker-driven treatment options for hormone receptor–positive breast cancer.

Micro-imaging characterization of mouse models of metastasis

2005 ◽  
Author(s):  
◽  
Christopher Todd Winkelmann
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Mouse Models ◽  
Bone Lesion ◽  
Receptor Expression ◽  
Bone Lesions ◽  
Micro Ct ◽  
Peptide Receptor ◽  
Gastrin Releasing Peptide ◽  
Models Of Disease

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Non-invasive imaging techniques have been recently developed to characterize animal models of disease. The overarching hypothesis of this work explores the use of three micro-imaging modalities, including Micro-CT, PET and SPECT, to characterize tumor anatomical progression, metabolism, bone lesion remodeling, and/or gastrin releasing peptide receptor expression in mouse models of metastatic melanoma and prostate and breast cancer bone metastasis. Micro-CT was shown to provide excellent anatomical information about tumor progression in several different tissues including lung, bone, and subcutaneous tissues. Micro-PET imaging demonstrated increased tumor metabolism in melanoma tumors, but was not able to discern bone remodeling in breast cancer bone lesions. Micro-SPECT imaging demonstrated gastrin-releasing peptide receptor expression in a prostate cancer bone metastasis model. The results from this work demonstrate the ability of micro-imaging technologies to non-invasively probe mouse models of disease to obtain information in vivo that is not possible with ex vivo experimental techniques.

Detection of estrogen receptor in bone marrow from patients with metastatic breast cancer.

1987 ◽  
Vol 5 (11) ◽  
pp. 1779-1782 ◽  
Author(s):  
U Berger ◽  
J L Mansi ◽  
P Wilson ◽  
R C Coombes
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Endocrine Therapy ◽  
Tumor Cells ◽  
Epithelial Membrane Antigen ◽  
Metastatic Breast ◽  
Breast Cancers ◽  
Double Staining ◽  
Primary Tumors ◽  
Er Positive

We devised a method of detecting estrogen receptors (ER) in bone marrow metastases from patients with breast cancer. The method involves a sequential double-staining immunocytochemical technique, with a monoclonal antibody to ER and a polyclonal antibody recognizing epithelial membrane antigen to confirm the epithelial nature of suspected tumor cells. Twenty-seven patients were assessed: ten were found to have ER-positive tumor cells in the bone marrow; ten had ER-negative cells; and the remaining seven patients had no tumor cells in the bone marrow smears. Of the ten patients with ER-positive cells, eight (80%) either had a response to endocrine therapy, implying that they possess ER-positive breast cancers, or had ER-positive primary tumors as determined by the dextran-coated charcoal biochemical assay (DCC). Of the ten patients with ER-negative cells in the bone marrow, eight failed to respond to endocrine therapy. This technique therefore provides a means of predicting which patients will respond to endocrine therapy, and is particularly important in those patients whose ER status is unknown.

Detection of bone marrow involvement in breast cancer with magnetic resonance imaging.

1994 ◽  
Vol 12 (7) ◽  
pp. 1415-1421 ◽  
Author(s):  
S M Sanal ◽  
F W Flickinger ◽  
M J Caudell ◽  
R M Sherry
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Serum Alkaline Phosphatase ◽  
Bone Marrow Involvement ◽  
Stage Iv ◽  
Stage Ii ◽  
Stage Iii ◽  
Mri Findings ◽  
Two Stage ◽  
Bone Scans

PURPOSE To evaluate the value of magnetic resonance imaging (MRI) in detecting bone marrow metastases in patients with breast cancer. PATIENTS AND METHODS Twenty-three patients with breast cancer in various stages (stage IV, 11; stage III, five; stage II, seven) were evaluated for bone marrow involvement. MRIs of marrow from lumbar spine, pelvis, and proximal femora were obtained with a 1.5-Tesla unit. All patients underwent bilateral bone marrow aspirations and biopsies for histologic evaluation and immunostaining with monoclonal antibody (MoAB) against low-molecular weight cytokeratin (CAM 5.2). Marrow MRI findings were compared with technetium 99m bone scans. Patients with stage II or III disease were monitored for clinical outcome. Possible correlation of MRI findings with serum alkaline phosphatase level was explored. RESULTS Fourteen of 23 patients showed MRI abnormalities suggestive of metastatic marrow disease (stage IV, nine; stage III, two; stage II, three). In six patients with abnormal MRIs, histology and MoAB immunostaining confirmed marrow involvement (stage IV, five; stage III, zero; stage II, one). In the other eight patients with MRI abnormalities, neither of these methods confirmed the presence of marrow metastasis. Four of five operable breast cancer (stage II-III) patients with an abnormal initial MRI showed additional abnormalities on follow-up examination and developed metastatic disease within 5 to 18 months demonstrable by conventional clinical methods. Conversely, none of the operable patients with negative MRIs developed recurrent disease at 3 to 16 months (Student's t test, P = .01). Nine patients with a normal MRI had no evidence of marrow involvement with histologic or MoAB immunostaining (stage IV, two; stage III, two; stage II, five). Of 14 patients with abnormal MRIs, bone scans were normal in seven and failed to show corresponding abnormalities in six. Elevated serum alkaline phosphatase levels showed a direct relationship with abnormal bone scans indicating extensive bony involvement, but failed to correlate with positive marrow MRIs. CONCLUSION MRI is a promising new technique to detect occult marrow involvement in breast cancer patients. There is a good correlation between abnormal marrow MRI and early development of clinical metastatic disease in patients with stage II to III disease.

Bone marrow involvement in breast cancer with pancytopenia: A case of good target selection

2008 ◽  
Vol 26 (15_suppl) ◽  
pp. 12026-12026 ◽  
Author(s):  
G. Valmadre ◽  
R. Epis ◽  
A. Pastorini ◽  
C. Castello
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Target Selection ◽  
Bone Marrow Involvement ◽  
Good Target

scholarly journals Case Report: Long-Term Response to Pembrolizumab Combined With Endocrine Therapy in Metastatic Breast Cancer Patients With Hormone Receptor Expression

2021 ◽  
Vol 12 ◽  
Author(s):  
Dingyong Wu ◽  
Shu Tang ◽  
Rong Ye ◽  
Dongmei Li ◽  
Dejian Gu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Endocrine Therapy ◽  
Hormone Receptor ◽  
Metastatic Breast ◽  
Shannon Index ◽  
Receptor Expression ◽  
Combination Regimen ◽  
Clinical Biomarkers ◽  
Tcr Repertoire

Breast cancer is one of the most commonly diagnosed malignancies. Although endocrine therapy improves the survival of patients with hormone receptor (HR)-positive breast cancer, the post-endocrine therapy strategy for metastatic breast cancer remains challenging. Herein, we report two patients who benefited from antiestrogen agents combined with an immunotherapy regimen to support the notion that an immunotherapy combination regimen may be a potential treatment for patients with HR-positive metastatic breast cancer post-endocrine therapy. Case 1 involved a patient with relapsed breast cancer with ovarian and brain metastases after endocrine therapy. After undergoing surgery for the ovarian lesions, she received three cycles of chemotherapy. Given that the lesions in the brain did not change, chemotherapy was discontinued. A high T cell receptor (TCR) repertoire (high Shannon index and clonality) was observed in the tumor. Considering the patient's preference and safety, and the efficacy of immunotherapy, she was administered with letrozole combined with pembrolizumab. The patient achieved a partial response, and the progression-free survival (PFS) was more than 21 months. Case 2 involved a patient with breast cancer with multiple bone metastases. After failure of combined radiotherapy and chemotherapy, the patient received tamoxifen combined with pembrolizumab based on the patient's preference and clinical biomarkers of a positive differentiation cluster of eight tumor-infiltrating lymphocytes and a high TCR repertoire (high Shannon index and clonality) in the tumor. The patient's bone pain and biomarkers were relieved after the treatment. The patients completed six cycles of pembrolizumab, and the PFS was more than 21 months. In conclusion, our study confirmed that antiestrogen agents combined with an immunotherapy regimen is a promising treatment for patients with HR-positive metastatic breast cancer.

Outcome of breast cancer with symptomatic bone marrow involvement.

2015 ◽  
Vol 33 (15_suppl) ◽  
pp. e12611-e12611
Author(s):  
Carlos O Munive ◽  
Maria F Muro ◽  
Greenlandia Ferreyros ◽  
Miluska Mayuri ◽  
Joseph A. Pinto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Marrow ◽  
Bone Marrow Involvement
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