title: Response of extensive breast cancer skin metastases to rechallenge with trastuzumab together with low-dose chemotherapy and insulin.
abstract: BACKGROUND
  Cutaneous metastasis occurs in about 29% of breast cancer patients and has a deep impact on patient quality of life.
  
  
  METHODS
  A 60-year-old woman with cutaneous metastases from heavily pretreated HER2-positive breast cancer received CMFVP (oral cyclophosphamide 100 mg daily; oral prednisone 12.5 mg daily for 2 weeks, then 7.5 mg daily; intravenous weekly methotrexate 25 mg/m2, 5-5-fluorouracil 400 mg/m2 and vincristine 0.5 mg) with weekly trastuzumab and subcutaneous insulin until disease progression.
  
  
  RESULTS
  From March 2009 to November 2009 the patient was treated with the described regimen. At the best response, we observed the disappearance of some lesions and cessation of bleeding and thoracic pain. Time to progression was 8 months.
  
  
  CONCLUSIONS
  Our patient had clinical benefit from reintroduction of trastuzumab, low-dose chemotherapy and insulin. The explanation of this prolonged response is only speculative and requires further clinical confirmation in the treatment strategy of HER2-positive breast cancer.
authors.affiliation:  Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi - Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Orlando
authors.affiliation:  Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi - Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Schiavone
authors.affiliation:  Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Calvani
authors.affiliation:  Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi - Italy.
authors.forename: Palma
authors.initials: P
authors.lastname: Fedele
authors.affiliation:  Department of Medicine, European Institute of Oncology, Milan - Italy.
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.affiliation:  Medical Oncology Division and Breast Unit, Antonio Perrino Hospital, Brindisi - Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Cinieri
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000235:genetics; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D000068878:Trastuzumab / Q000008:administration & dosage; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D003520:Cyclophosphamide; D005472:Fluorouracil; D007328:Insulin; D008727:Methotrexate; D011241:Prednisone; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; D014750:Vincristine