title: Lasting remission following multimodal treatment in a patient with metastatic breast cancer.
abstract: We report on a lasting remission from multimodal treatment in a patient with hepatic metastasized breast cancer. After surgical removal of a singular hepatic metastasis, the patient underwent leukapheresis of peripheral blood mononuclear cell (PBMCs). For induction chemotherapy, the patient received 2 cycles of epirubicin and paclitaxel (ET). After 1 cycle of epirubicin and ifosfamide (EI), peripheral blood stem cells were harvested. After a final cycle of ET, the patient underwent high-dose chemotherapy (HDCT; thiotepa 600 mg/m/melphalan 180 mg/m) and autologous stem cell transplantation. Once reconstitution was achieved, PBMCs were reinfused followed by i.v. application of a trifunctional antibody (TrAb) with specificities anti-EpCAMxanti-CD3. TrAbs are able to simultaneously bind tumor cells, T cells, and additionally FcgammaR type I and III+accessory cells via their Fc region. Side-effects during treatment were hematotoxicity, mucositis and gastrointestinal toxicity. TrAb treatment resulted in intermittent fever, chills, elevated liver enzymes, systemic inflammatory response syndrome and pulmonary leakage. With a follow-up period of more than 8 years the patient is still in remission (96+months). This case suggests the feasibility and efficacy of combining surgery, standard and HDCT, and subsequent immunotherapy in metastatic breast cancer. Further investigation of this approach is indicated in a subgroup of patients with oligometastatic breast cancer.
authors.affiliation: Department of Hematology/Oncology, Klinikum Grosshadern, University of Munich, Munich, Germany. Joachim.Stemmler@med.uni-muenchen.de
authors.forename: H J
authors.initials: HJ
authors.lastname: Stemmler
authors.forename: H
authors.initials: H
authors.lastname: Menzel
authors.forename: C
authors.initials: C
authors.lastname: Salat
authors.forename: H
authors.initials: H
authors.lastname: Lindhofer
authors.forename: S
authors.initials: S
authors.lastname: Kahlert
authors.forename: V
authors.initials: V
authors.lastname: Heinemann
authors.forename: H J
authors.initials: HJ
authors.lastname: Kolb
mesh_terms: D000328:Adult; D000906:Antibodies / Q000627:therapeutic use; D000951:Antigens, Neoplasm / Q000276:immunology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D017252:CD3 Complex / Q000276:immunology; D015815:Cell Adhesion Molecules / Q000276:immunology; D003131:Combined Modality Therapy / Q000009:adverse effects; D015251:Epirubicin / Q000627:therapeutic use; D000071858:Epithelial Cell Adhesion Molecule; D005260:Female; D006801:Humans; D007937:Leukapheresis; D008113:Liver Neoplasms / Q000556:secondary*; D017239:Paclitaxel / Q000627:therapeutic use; D012074:Remission Induction; D013852:Thiotepa / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D000951:Antigens, Neoplasm; D017252:CD3 Complex; D015815:Cell Adhesion Molecules; C499379:EPCAM protein, human; D000071858:Epithelial Cell Adhesion Molecule; D015251:Epirubicin; D013852:Thiotepa; D017239:Paclitaxel