title: Androgen deprivation by adrenal suppression using low-dose hydrocortisone for the treatment of breast carcinoma with apocrine features: a case report illustrating this new paradigm.
abstract: We report on a postmenopausal patient with a secondary metastatic apocrine breast cancer successfully treated with low-dose hydrocortisone only following several lines of chemotherapy. The tumor cells in the primary and metastatic lesion exhibited a 'triple-negative' status (estrogen receptor (ER)-, progesterone receptor (PR)-, and human epidermal growth factor receptor 2 (HER2)-negative); the androgen receptor (AR) was strongly expressed. Twenty milligrams of hydrocortisone, a low substitution dose known to suppress adrenal steroid production, twice daily led to a clinical benefit lasting for one year, with symptom control, radiologically stable disease, and steady decrease in CA15.3. Our observation demonstrates that an AR-expressing apocrine breast cancer may respond to androgen deprivation, as an ER-positive breast cancer may benefit from estrogen deprivation. It highlights the importance of further research targeting the AR pathway in apocrine carcinoma, for which androgens represent the sole (known) steroid hormone stimulating tumor growth. Future clinical trials should not only focus on AR inhibitors like enzalutamide, but also on ablative modalities like low-dose hydrocortisone aiming at medical adrenalectomy. This method of androgen deprivation is largely available, cheap, and nearly devoid of toxicity.
authors: Department of Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium. lynn.jongen@uzleuven.be.
authors: Lynn
authors: L
authors: Jongen
authors: Department of Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.|Department of General Medical Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Robert
authors: R
authors: Paridaens
authors: Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research, KU Leuven - University of Leuven, Leuven, Belgium.|Department of Pathology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Giuseppe
authors: G
authors: Floris
authors: Department of Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.|Department of General Medical Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Hans
authors: H
authors: Wildiers
authors: Department of Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.|Department of Gynecology and Obstetrics, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
authors: Patrick
authors: P
authors: Neven
mesh_terms: D000726:Androgen Antagonists / Q000008:administration & dosage*; D000728:Androgens / Q000235:genetics*; D001050:Apocrine Glands / Q000187:drug effects / Q000473:pathology; D014408:Biomarkers, Tumor / Q000235:genetics; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology; D000069287:Capecitabine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008875:Middle Aged; D018396:Mucin-1 / Q000235:genetics; D017698:Postmenopause; D011944:Receptors, Androgen / Q000235:genetics
chemical_list: C410798:AR protein, human; D000726:Androgen Antagonists; D000728:Androgens; D014408:Biomarkers, Tumor; D018396:Mucin-1; D011944:Receptors, Androgen; D000069287:Capecitabine; D006854:Hydrocortisone
keywords: Androgen deprivation therapy; Androgen receptor; Apocrine; Breast cancer; Hydrocortisone