Neoadjuvant combination therapy with trastuzumab in a breast cancer patient with synchronous rectal carcinoma: a case report and biomarker study

• Main Authors: Vitásková Denisa, Melichar Bohuslav, Bartoušková Marie, Vlachová Zuzana, Vrána David, Janková Jana, Adam Tomáš, Juráňová Jarmila, Zlámalová Nora, Kujovská Krčmová Lenka, Javorská Lenka, Klos Dušan, Študentová Hana
• Format: Article
• Language: English
• Published: De Gruyter 2017-12-01
• Series: Pteridines
• Subjects: breast cancer; chemoradiation; neoadjuvant therapy; neopterin; trastuzumab
• Online Access: https://doi.org/10.1515/pterid-2017-0017

We report a patient who presented with synchronous second primary human epidermal growth factor receptor (HER)-2-positive breast cancer and rectal cancer that both required simultaneous neoadjuvant therapy. A modified regimen combining anti-HER-2 monoclonal antibody trastuzumab with chemotherapy and external beam radiation was selected. An organ-preserving surgical procedure was possible both in the breast and the rectum. Citrulline decreased rapidly after the start of the treatment, and then gradually returned to pre-treatment levels after the completion of chemoradiation. Urinary neopterin concentrations exhibited a fluctuating course. Both serum neopterin and C-reactive protein concentrations were more or less stable during the initial administration of trastuzumab, paclitaxel and carboplatin and then increased steeply during chemoradiation and subsequently declined to pre-treatment levels during the weekly trastuzumab administration. Changes were observed in the serum retinol concentrations. A decline in lymphocyte counts was accompanied by marked changes in peripheral blood cell count-derived ratios. The present case report demonstrates a successful combination of two neoadjuvant regimens in a patient with two synchronous different second primary tumors. Data from this case also illustrate the use of biomarkers for monitoring of intensive therapeutic regimens in medical and radiation oncology.