Background: The number of elderly patients with breast cancer has increased in recent years, many of whom reside alone. This makes choosing their treatment difficult because of domestic considerations and declining physical and cognitive functions. Chemotherapy is often omitted owing to age, and treatment can subsequently be inadequate.
Case presentation: Our patient was an 82-year-old woman presenting with the chief complaint of an enlarged left breast mass. The mass had undergone self-destruction with hemorrhage and enlarged left axillary and supraclavicular lymph nodes. She lived alone; therefore, initial chemotherapy of trastuzumab (HER)+pertuzumab (PER)+weekly paclitaxel (wPTX) two-step dose reduction was performed in the hospital. A subcutaneous mass appeared, which disappeared after irradiation. Subsequently, tri-weekly HER+PER administration was continued.
Conclusion: A multidisciplinary approach to therapy may offer elderly patients living alone with inoperable breast cancer patients the ability to continue treatment and control their disease following careful consideration of their comorbidities and decline in physical and cognitive functions. Such multidisciplinary treatment options minimize the occurrence of side effects, allowing for long-term continuation of therapy, helping to maintain quality of life and potentially prolonging overall survival.
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Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neu oncogene. Science. 1987;235(4785):177–182. doi: 10.1126/science.3798106.
Clark GM, McGuire WL. Follow-up study of HER-2/neu amplification in primary breast cancer. Cancer Res. 1991;51(3):944–948.
Seshadri R, Firgaira FA, Horsfall DJ, McCaul K, Setlur V, Kitchen P. Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group. J Clin Oncol. 1993;11(10):1936–1942. doi: 10.1200/JCO.19184.108.40.2066.
Dawood S, Broglio K, Buzdar AU, Hortobagyi GN, Giordano SH. Prognosis of women with metastatic breast cancer by HER2 status and trastuzumab treatment: an institutional-based review. J Clin Oncol. 2010;28(1):92–98. doi: 10.1200/JCO.2008.19.9844.
The Japanese Breast Cancer Society Clinical Practice Guidelines for Breast Cancer 2022, KANEHARA Syuppan. Tokyo; 2022, p.141-144.
Yoshioka S, Hojo S, Toyoda Y, Ito Y, Fukata T, Miyagaki M, et al. A case of an elderly with locoregional recurrence of ER-negative HER2-positive breast cancer successfully treated with local therapy. Jpn J Cancer Chemother. 2018;45(13):2232–2234.
Okishiro S, Egawa C, Kusama H, Matsushita K, Hashimoto T, Mukai Y, et al. Analysis of elderly breast cancer patients aged 90 years and older. Jpn J Cancer Chemother. 2013;40(12):2402–2404.
Ministry of Health, Labour and Welfare: Abridged Life Tables for Japan 2020.
Naito Y, Mukai H, Nagai S. Elderly breast cancer therapy: A Japanese experience. Jpn J Clin Oncol.2010;40(8):717–721. DOI: 10.1093/jjco/hyq061.
Sawaki M, Taira N, Uemura Y, Saito T, Baba S, Kobayashi K, et al. Randomized controlled trial of trastuzumab with or without chemotherapy for HER2-positive early breast cancer in older patients. J Clin Oncol. 2020;38(32):3743–3752. DOI: 10.1200/JCO.20.00184.
Semiglazov VF, Topuzov EE, Bavli JL, Moiseyenko VM, Ivanova OA, Selezneve IK, et al. Primary (neoadjuvant) chemotherapy and radiotherapy compared with primary radiotherapy alone in stage Ⅱb-Ⅲa breast cancer. Ann Oncol. 1994;5:591–595. DOI: 10.1093/oxfordjournals.annonc.a058929.
Courdi A, Ortholan C, Hannoun-Lévi JM, Ferrero JM, Largillier R, Balu-Maestro C, et al. Long-term results of hypofractionated radiotherapy and hormonal therapy without surgery for breast cancer in elderly patients. Radiother Oncol. 2006;79(2):156–161. doi: 10.1016/j.radonc.2006.04.005.
Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25(22):3259–3265. doi: 10.1200/JCO.2007.11.4991.
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