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Local recurrence, Breast cancer, Systemic therapy, Chemotherapy
Background: Locoregional recurrence of breast cancer has significantly decreased over the last decades, particularly due to effective systemic therapy. While there is little controversy regarding local management of locoregional recurrences, in light of previous systemic treatment, additional chemotherapy regimens and their benefit to the patient are still subject to debate in tumors boards.
Case Presentation: A 45-year-old woman was referred to our tertiary care center with a local recurrence of breast cancer 9 years after modified radical mastectomy for a ypT2N2a invasive ductal carcinoma. She received neoadjuvant treatment consisting of FEC-D (5-FU-epirubicin-cyclophosphamide, followed by docetaxel) for hormone receptor positive, HER-2-neu negative cancer in 2009, as well as adjuvant radiotherapy and tamoxifen for 9 years. After R0 resection of the hormone receptor positive, HER-2-neu negative recurrence in 2019, adjuvant therapy with ovarian suppression and an aromatase inhibitor was undertaken. A multigene assay identified a recurrence score at 37 and benefit from chemotherapy > 15%.
Question: What would the ideal chemotherapy regimen consist of for this patient with an R0 resection of late recurrence of breast cancer?
Conclusion: After reviewing history, imaging and pathology, members of the multidisciplinary team recommended treatment with Taxotere and cyclophosphamide (TC) x 4 for our patient.
2. Mamounas EP, Tang G, Liu Q. The importance of systemic therapy in minimizing local recurrence after breast-conserving surgery: the NSABP experience. J Surg Oncol. 2014;110(1):45-50.
3. Lowery AJ, Kell MR, Glynn RW, Kerin MJ, Sweeney KJ. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2012;133(3):831-41.
4. Huang EH, Tucker SL, Strom EA, McNeese MD, Kuerer HM, et al. Predictors of locoregional recurrence in patients with locally advanced breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62(2):351-7.
5. Swisher SK, Vila J, Tucker SL, Bedrosian I, Shaitelman SF, et al. Locoregional Control According to Breast Cancer Subtype and Response to Neoadjuvant Chemotherapy in Breast Cancer Patients Undergoing Breast-conserving Therapy. Ann Surg Oncol. 2016;23(3):749-56.
6. Pivot X. Adjuvant chemotherapy for local relapse breast cancer. Lancet Oncol. 2014;15(2):125-6.
7. Waeber M, Castiglione-Gertsch M, Dietrich D, Thurlimann B, Goldhirsch A, et al. Adjuvant therapy after excision and radiation of isolated postmastectomy locoregional breast cancer recurrence: definitive results of a phase III randomized trial (SAKK 23/82) comparing tamoxifen with observation. Ann Oncol. 2003;14(8):1215-21.
8. Aebi S, Gelber S, Anderson SJ, Lang I, Robidoux A, et al. Chemotherapy for isolated locoregional recurrence of breast cancer (CALOR): a randomised trial. Lancet Oncol. 2014;15(2):156-63.
9. Wapnir IL, Price KN, Anderson SJ, Robidoux A, Martin M, et al. Efficacy of Chemotherapy for ER-Negative and ER-Positive Isolated Locoregional Recurrence of Breast Cancer: Final Analysis of the CALOR Trial. J Clin Oncol. 2018;36(11):1073-9.
10. Belkacemi Y, Hanna NE, Besnard C, Majdoul S, Gligorov J. Local and Regional Breast Cancer Recurrences: Salvage Therapy Options in the New Era of Molecular Subtypes. Front Oncol. 2018;8:112.
11. Altundag K. Adjuvant chemotherapy might show benefit in luminal B breast cancer patients with isolated locoregional recurrence. J BUON. 2019;24(1):405-6.
12. McAnena PF, McGuire A, Ramli A, Curran C, Malone C, et al. Breast cancer subtype discordance: impact on post-recurrence survival and potential treatment options. BMC Cancer. 2018;18(1):203.