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Erlotinib-Induced Breast Cancer Regression

Staff Assistant, Medical Care Unit, Department of Medicine, European Institute of Oncology, Milan, Italy

Tommaso Martino De Pas, MD

Deputy Director, Unit of New Drugs and Clinical Pharmacology, Department of Medicine, European Institute of Oncology

Giuseppe Pelosi

Professor, Deputy Director, Division of Pathology and Laboratory Medicine, European Institute of Oncology; Professor, University of Milan School of Medicine, Milan

Michela Manzotti, MD

Staff Assistant, Division of Pathology and Laboratory Medicine, European Institute of Oncology

Laura Adamoli, PhD

Data Manager Staff, Department of Medicine, European Institute of Oncology

Franco Nolè, MD

Director, Medical Care Unit, European Institute of Oncology

Aron Goldhirsch, MD

Professor and Director, Department of Medicine, European Institute of Oncology

Reprints: Dr. Catania, Medical Care Unit, Department of Medicine, European Institute of Oncology, Via Ripamonti, 435, 20141 Milan, Italy, fax 39 2 57489457, chiara.catania{at}ieo.it

OBJECTIVE: To report a case of erlotinib-induced breast cancer regression.

CASE SUMMARY: A 38-year-old woman developed bilateral locoregional malignant cutaneous lymphangitis following a right subcutaneous mastectomy and 3 months of adjuvant chemotherapy. After several systemic chemotherapy regimens, the lymphangitis worsened rapidly, with progressive skin ulceration. Morphine and dexamethasone were given, with suboptimal pain control. A chemotherapy regimen of gemcitabine and vinorelbine was started. After 2 full-dose administrations, while lymphangitis continued to worsen, erlotinib 150 mg/day was added to the regimen. After 10 weeks of treatment, pain subsided and analgesics were discontinued. Physical examination revealed a partial regression of malignant cutaneous lymphangitis and pulmonary metastases, with resolution of ulceration.

DISCUSSION: There has been increased interest in epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in the treatment of breast cancer. Gefitinib has shown a low level of efficacy, while preliminary clinical data on erlotinib were not conclusive and suggested lack of clinical activity. Molecular analysis of the tumor in our patient revealed a profile predictive of response to EGFR selective inhibitors in some patients with lung cancer.

CONCLUSIONS: The addition of erlotinib to our patient's chemotherapy regimen resulted in antitumor activity in breast cancer in which an activated EGFR pathway was demonstrated. This finding is consistent with available preclinical and clinical data on EGFR tyrosine kinase inhibitors across tumor types and supports the efforts to optimize EGFR selective inhibitors in treating breast cancer and other malignancies.

Key Words: breast cancer, EGFR inhibitors, erlotinib

Published Online, October 24, 2006. www.theannals.com, DOI 10.1345/aph.1H252

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