title: Cutaneous Metastasis due to Breast Cancer in a Patient with Primary Biliary Cirrhosis: A Case Report.
abstract: BACKGROUND
  Breast cancer is the most common solid tumor to cause cutaneous metastases. These are incurable and the treatment goal is geared toward local control with surgical excision, radiation, and chemotherapy. However, treatment can be challenging in subjects with end-stage liver disease and a multidisciplinary approach is warranted.
  
  
  METHODS
  In this case report, we present a 61-year-old female with primary biliary cirrhosis and human epidermal growth factor-2 (HER-2)-positive breast cancer, who subsequently developed cutaneous metastases. We briefly describe the treatment challenges due to underlying end-stage liver disease, and an exceptional response to trastuzumab and nab-paclitaxel.
  
  
  CONCLUSIONS
  A multidisciplinary approach to local control and attenuated doses of nab-paclitaxel and trastuzumab suggest a durable response to HER-2-positive breast cancer with cutaneous metastasis. Subjects with end-stage liver disease pose unique challenges and toxicities, warranting additional research and drug development for less hepatotoxic antineoplastic agents.
authors.affiliation: Department of Internal Medicine, Department of Clinical Nursing, Department of Radiation Oncology, and Department of Pharmacy, Froedtert/Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Sailaja
authors.initials: S
authors.lastname: Kamaraju
authors.affiliation: Department of Internal Medicine, Department of Clinical Nursing, Department of Radiation Oncology, and Department of Pharmacy, Froedtert/Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Depke
authors.affiliation: Department of Internal Medicine, Department of Clinical Nursing, Department of Radiation Oncology, and Department of Pharmacy, Froedtert/Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Povletich
authors.affiliation: Department of Internal Medicine, Department of Clinical Nursing, Department of Radiation Oncology, and Department of Pharmacy, Froedtert/Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Currey
authors.affiliation: Department of Internal Medicine, Department of Clinical Nursing, Department of Radiation Oncology, and Department of Pharmacy, Froedtert/Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weil
keywords: Cutaneous metastasis; HER-2-positive breast cancer; Nab-paclitaxel; Primary biliary cirrhosis