Long-term control of recurrent disease in a patient with hormones receptor-positive breast cancer

A 45-year-old female was diagnosed with infiltrating duct carcinoma (IDC) left breast in 1982. She underwent a mastectomy followed by locoregional radiotherapy and chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil. The patient developed left axillary swelling (3 cm × 3 cm) in 2004; fine-needle aspiration cytology (FNAC) was suggestive IDC, metastatic. The patient was started on tablet letrozole 2.5 mg but stopped it due to a cardiac problem. She reported with increase in the size of left axillary swelling in 2008. FNAC was reported as IDC, recurrence. There were no metastases on further workup. She was started on exemestane 25 mg and was also given radiotherapy to the left axilla. In 2012, bone scan was suggestive of multiple skeletal metastases. She was put on exemestane till 5 years. Again in 2013, she had left axillary swelling but the patient was not willing for FNAC. The patient was now started on anastrozole 1 mg. She again had back pain; bone scan was done and it was suggestive of multiple skeletal metastases. She was continued on anastrazole. In February 2015, she developed small nodules in the left axilla and anterior abdominal wall. FNAC of both sites was positive for carcinoma, metastatic. Bone scan again showed multiple skeletal metastases. Positron emission tomography scan did suggest local recurrence with metastatic radiculopathy in left axilla and widespread metastases Biopsy from the left axilla revealed IDC and it was strong estrogen receptor, progesterone receptor positive, and Her 2 neu negative. She was 78 years now with KPS 40 and cardiac morbidity. Her disease progressed rapidly to lungs and she died.