Breast cancer affects approximately 12% of women worldwide and results in 14% of all cancer-related deaths. Despite the diffusion of screening programs, about 6% of women still have metastatic disease at the onset presentation. Median Overall Survival (OS) of patients with Metastatic Breast Cancer (MBC) is extremely variable (8 months to 4 years). In the last decades, with the advent of new cytotoxic drugs and targeted therapies, a significant increase in OS of MBC patients has been achieved. Nevertheless, in the majority of cases, after an initial response to treatment, the development of highly aggressive and drug-resistant disease is commonly observed. For these reasons, the current goals are not only the prolongation of OS, but also the improvement of the Quality of Life (QoL) through disease control and drug-related toxicities management. Gemcitabine (2’,2’-difluorodeoxycytidine) is a nucleoside analog that makes its antiproliferative activity through two active metabolites, gemcitabine di- and triphosphate.
The safety profile is good with a limited,mainly hematological, toxicity. This drug has been approved not only for the treatment of MBC but also for pancreatic lung bladder and ovarian tumors. Even if gemcitabine has been shown to be effective in combination with paclitaxel for the first-line treatment of MBC its use as single agent in pre-treated patients has given only a small benefit in several reports. Here we report the case of a MBC patient that, after several failing attempts with drugs commonly more effective than gemcitabine, achieved the complete remission of disease with this antimetabolite in more than one treatment-line. The overall benefit from the drug lasted more than 10 years. This case report highlights the existence of a small percentage of MBC patients that could obtain a terrific benefit from a low toxic and often underestimated drug for this pathology, in urgent need for new predictive biomarkers.
We describe the case of a 52-year old caucasian woman, in good clinical condition (ECOG performance status: 0), affected by essential hypertension, chronic hepatitis C infection and mild depressive syndrome. In January 1999, she underwent left upper quadrantectomy and ipsilateral axillary lymphadenectomy. The pathology report showed a bifocal invasive ductal carcinoma (stage pT2N3M0); by immunohistochemistry, neoplastic cells stained positive for Her2 (IHC: 3+) and negative for Hormone Receptors (HRs). Chemotherapy (4 cycles of doxorubicin plus paclitaxel q21, followed by CMF 1-8q28, for 4 cycles) and radiotherapy (50 Gy) were performed with adjuvant intent.
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