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An effective 5-fluorouracil, levofolinate, and oxaliplatin therapy for recurrent breast cancer: a case report
© Takahashi et al.; licensee BioMed Central Ltd. 2014
Received: 22 January 2014
Accepted: 15 May 2014
Published: 26 June 2014
Therapy comprising 5-fluorouracil, levofolinate, and oxaliplatin is currently the most common chemotherapy for colorectal cancer. We experienced a successful case of advanced colon cancer and recurrent breast cancer with 5-fluorouracil, levofolinate, and oxaliplatin therapy.
A 43-year-old Japanese woman who had already undergone surgery three times for bilateral breast cancer was admitted to our hospital for the treatment of advanced transverse colon cancer. Preoperative computed tomography demonstrated a swollen lymph node at her right upper clavicle, and fine-needle aspiration biopsy of the lymph node showed that it was a metastasis from the breast cancer. A laparoscopic-assisted colectomy was performed and the pathology demonstrated that the final stage was IIIC (T4aN2aM0, Union for International Cancer Control, 7th edition). The pathological findings and immunohistochemistry showed that the transverse colon tumor was not a metastatic lesion from the breast cancer, but was a de novo colon cancer. Chemotherapy was necessary for both the recurrent breast cancer and the Stage IIIC colon cancer. Therapy of 5-fluorouracil, levofolinate, and oxaliplatin was administered; the therapy included 5-fluorouracil, which is considered to be effective for both colon and breast cancer. After two courses of 5-fluorouracil, levofolinate, and oxaliplatin, the lymph node began to shrink and almost completely disappeared after eight courses of 5-fluorouracil, levofolinate, and oxaliplatin.
We surmise that 5-fluorouracil, levofolinate, and oxaliplatin have the potential to provide a good response for tumors that are sensitive to fluorinated pyrimidine and platinum-containing anticancer drugs such as breast cancer.
A combination therapy of three drugs, 5-fluorouracil (5FU), levofolinate (l-LV) and oxaliplatin (L-OHP; FOLFOX) plays an important role in chemotherapy for colon cancer . We have experienced a successful case in which FOLFOX therapy, as postoperative adjuvant chemotherapy for locally advanced colon cancer, was also effective for the upper cervical lymph node metastasis of a recurrent breast cancer.
Operative history of our case
No. of surgery
Immunohistochemical staining of surgical specimen
Rad, CEF, PTX+Tmab
The medications to treat breast cancer include anticancer drugs, hormone drugs and molecular target drugs, and they are commonly used as monotherapies or in combination . Of the anticancer drugs, anthracyclines and taxanes have played a central role. While fluorinated pyrimidines have been administered to patients with breast cancer, they are not administered mainly as key drugs, but more often as adjuvant chemotherapy in combination chemotherapy, including cyclophosphamide, methotrexate and 5FU (CMF) and CEF. Injectable, oral, ointments and suppositories of fluorinated pyrimidines have been developed. In particular, the current oral anticancer drugs have provided a good response rate against breast cancer (capecitabine, tegafur-gimeracil-oteracil potassium) . In this case, we recommended adjuvant chemotherapy after curative colon cancer resection, because of the pathological diagnosis as Stage IIIC. At the same time, chemotherapy for the recurrent breast cancer was also needed. Thus, we decided to utilize the FOLFOX regimen including 5 FU, a fluorinated pyrimidine anticancer drug, as a protocol that was applicable to both colon and breast cancer. FOLFOX is a regimen that includes a combination of three drugs, 5FU, l-LV and L-OHP, and a large dose of 5FU can be administered by intravenous bolus and continuous intravenous infusion. By administering 5FU instead of uracil, which is incorporated in the nucleic acid synthesis of cancer cells, a ternary complex (TC) is formed with a folate-related substance, l-LV, and thymidylate synthase, thus, inhibiting deoxyribonucleic acid (DNA) synthesis within the cancer cells. As a result, the combination of 5FU and l-LV should increase the antitumor effect in tumors compared with 5FU monotherapy. Folate concentrations are the highest 2 hours after l-LV administration. Therefore, intravenous bolus of 5FU at that time results in the production of high levels of the TC, and 46-hour continuous intravenous infusion of 5FU maintains the TC level for a long time and enhances the inhibition of DNA synthesis to induce anticancer effects . However, the platinum-derivative L-OHP produces crosslinks between DNA purines and inhibits DNA synthesis, resulting in anticancer effects . FOLFOX is a regimen that improves the response rate through a combination of 5FU+l-LV and L-OHP. FOLFOX is currently specific to colon cancer and is used for unresectable or metastatic colon cancer, as well as adjuvant therapy after advanced colon cancer surgery; playing an important role in chemotherapy for colon cancer with a good response rate. However, the platinum-containing anticancer drugs, platinum-derivatives, are not applicable for the treatment of breast cancer in Japan. However, several recent studies have reported that L-OHP has a good response rate in the treatment of breast cancer. For example, some studies of the combination of L-OHP with 5FU and l-LV for recurrent breast cancer have been conducted in Europe and the United States of America and have confirmed the safety and efficacy in a Phase II study [9–11]. While this patient had previously been treated with fluorinated pyrimidine anticancer drugs, such as 5FU and UFT, we expected that the addition of l-LV might increase the anticancer effect. Furthermore, FOLFOX often provides a good response in patients who are resistant to fluorinated pyrimidine anticancer drugs or 5FU+l-LV for colorectal cancer and gastric cancer [12, 13]. Based on these considerations, we chose FOLFOX and consequently achieved a good response.
We treated a patient with Stage IIIC colon cancer that relapsed after surgery for breast cancer, using FOLFOX as a postoperative adjuvant chemotherapy and demonstrated a successful response for recurrent breast cancer. Thus, we surmise that FOLFOX has the potential to provide a good response for tumors that are sensitive to fluorinated pyrimidine and platinum-containing anticancer drugs.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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