A 65/M a known case of coronary artery disease and valvular heart disease with valve replacement done in 1991, developed carcinoma breast in September of 2010. In addition he had co-morbidities of NIDDM. He was planned for surgery, but developed a stroke 2 days prior to surgery, which was then abandoned. He was started on hormone therapy (Anastrozole 1mg/day) as he was positive for hormone receptor on the tumor, namely estrogen receptor and progesterone receptor.
He did well for 18 months (till March 2012), and progressed as chest wall nodules reappeared. He received radiotherapy to the chest wall to which he responded well and remained so till December 2013, when he developed small nodules at the same site which gradually increased and ulcerated. He was not offered any treatment at various centers he approached other than just 2nd and 3rd line hormonal therapy (Tamoxifen and Letrozole) for the fear of excessive toxicity, which he took without any benefit. He came to us in June 2014 with extensive ulcerated lesions on right side of the chest wall which bled (as patient was on warfarin) on mere touch of clothes (Figure A and B). PET CT showed extensive spread in lung and bones too. Echocardiography showed an ejection fraction of 20%. Clinically patient was well-preserved – and a repeat biopsy showed adenocarcinoma which was now negative for hormone receptor, hence option of using or continuing hormone therapy was ruled out.
He was offered chemotherapy after due discussion of benefits and risk, with vinorelbine which is considered cardiac and renal safe. Post just 2 cycles there was significant clearing of the chest lesions (Fig. C). And post 3 cycles there was further improvement with all lesions showing healing and no evidence of any bleeding (Fig. D). He continues to receive therapy and recently took his 4th cycle and is tolerating chemotherapy well, with significant improvement of quality of life.
The case highlights the success of chemotherapy in otherwise compromised patients as above.