Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7146-7153
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7146
S-1 plus temozolomide as second-line treatment for neuroendocrine carcinoma of the breast: A case report
Xin Wang, Yan-Fen Shi, Jiang-Hui Duan, Chao Wang, Huang-Ying Tan
Xin Wang, Beijing University of Chinese Medicine; Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing 100029, China
Yan-Fen Shi, Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Jiang-Hui Duan, Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
Chao Wang, Huang-Ying Tan, Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Wang X reviewed the literature and contributed to manuscript drafting; Shi YF provided pathological information; Duan JH analyzed and interpreted the imaging findings; Wang C contributed to data collection; Tan HY was responsible for the revision of the manuscript; all authors have read and approved the final version of the manuscript.
Informed consent statement: This patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huang-Ying Tan, MD, PhD, Chief Physician, Department of Integrative Oncology, China-Japan Friendship Hospital, No. 2 Yinghuadong Street, Beijing 100029, China. tanhuangying@263.net
Received: January 4, 2021
Peer-review started: January 4, 2021
First decision: April 25, 2021
Revised: April 27, 2021
Accepted: July 6, 2021
Article in press: July 6, 2021
Published online: August 26, 2021
Abstract
BACKGROUND

Neuroendocrine carcinoma of the breast (NECB) is a rare type of malignant tumor. Due to the rarity of NECB, the relevant literature mostly comprises case reports. Available data on treatment options for NECB are very limited.

CASE SUMMARY

A 62-year-old woman presented to our hospital in October 2016 for intermittent vomiting and diarrhea and masses in the liver found on abdominal computed tomography (CT) imaging. She was diagnosed in July 2012 with neuroendocrine carcinoma of the right breast in local hospital. The patient initially presented with a painful lesion of the right breast. She then undergone surgical resection and adjuvant chemotherapy with pirarubicin and paclitaxel for four cycles as well as endocrine therapy. She was regularly followed every 3 mo after surgery. Enhanced abdominal CT imaging at our hospital revealed multiple suspicious masses in the liver with the largest lesion measuring 8.4 cm × 6.3 cm. Chest CT revealed masses in the anterior chest wall and lung. Core needle biopsy of the lesion revealed liver metastases of NECB. A bone scan showed right second anterior rib metastases. Upper endoscopy and colonoscopy did not provide any evidence of another possible primary tumor. She stopped receiving endocrine therapy and then received etoposide and cisplatin (EP) chemotherapy as a first-line treatment regimen for six cycles at our hospital after liver, bone, and lung metastases. On October 2017, the chemotherapy regimen was changed to S-1 (40 mg twice daily, days 1-14) combined with temozolomide (200 mg once daily, days 10-14) (STEM) every 21 d as a second-line treatment regimen due to disease progression. Progression-free survival (PFS) and adverse effects after treatment were analyzed, and the efficacy of the STEM regimen was assessed using RECIST version 1.1. This patient achieved a partial response after using the STEM regimen, with a PFS of 23 mo. Adverse effects included only grade 1 digestive tract reactions with no need for a reduction in chemotherapy.

CONCLUSION

This case report suggests that the STEM regimen may be effective and well tolerated as the second-line treatment for advanced NECB. STEM is still highly effective in patients who show disease progression with the EP regimen. More evidence is needed to prove the validity of STEM.

Keywords: Neuroendocrine carcinoma, Breast, S-1, Temozolomide, Case report

Core Tip: Neuroendocrine carcinoma of the breast (NECB) is a highly malignant tumor. There is no standard treatment protocol for NECB due to its rarity. We treated an NECB patient with the S-1 combined with temozolomide (STEM) regimen as a second-line treatment due to disease progression. The effect of the STEM regimen on the patient was good, and she achieved a progression-free survival of 23 mo. During the chemotherapy period, the patient achieved a partial response and suffered only grade 1 adverse reactions. This report can serve as a reference for clinical practice.