Case series of metastatic breast cancer patients with visceral crisis treated with CDK4/6 inhibitors

Figures & data

Figure 1. Course of CA15-3 tumour marker tests from start of systemic therapy and during the first 6 months of systemic treatment. Case 4 switched to chemotherapy 2 months after diagnosis.

Table 1. Patient and tumour characteristics of patients per case at time of presentation.

Characteristics	Case 1	Case 2	Case 3	Case 4
Gender	Male	Male	Female	Female
Age (in years)	70	66	60	60
Medical history	None	None	Primary breast cancer, deep venous thrombosis arm	Hypertension, functional dyspepsia, spinal fusion for spondylolisthesis
WHO performance status	2	1	2	3
De novo/recurrent	de novo	de novo	recurrent	de novo
Oestrogen receptor	100%	95%	80%	100%
Progesterone receptor	70%	55%	80%	0%
HER2 receptor	Negative	Negative	Negative	Negative
Grade	2	1	3	2
Visceral metastases	Lungs	Lungs, adrenal, eyes	Lungs	Lungs, liver, spleen, peritoneal
Main symptoms	Dyspnoea	Weight loss Diplopia	Dyspnoea Weight loss	Dyspnoea Night sweating Weight loss
Response on CDK4/6 inhibitor according to RECIST 1.1	Partial response	Partial response	Stable disease	No response specified

Table 2. Laboratory results of patients per case at time of presentation with (impending) visceral crisis.

Test	Units	Reference	Case 1	Case 2	Case 3	Case 4
Hemoglobin	mmol/L	7.5–10.0	8.3	7.1	8.3	4.7
Platelet count	10E9/L	150–400	234	214	274	391
Leukocyte count	10E9/L	3.5–11.0	6.7	4.6	4.4	13.0
Calcium	mmol/L	2.10–2.55	2.43	1.53	2.40	2.71
Creatinine	umol/L	50–100	75	70	71	118
ASAT	U/L	<31	35	21	22	259
ALAT	U/L	<34	35	19	18	47
GGT	U/L	<38	49	38	64	457
ALP	U/L	<98	57	613	282	702
Bilirubin	umol/L	<20	6	8.3	5	7.4
LDH	U/L	<247	130	263	200	746
CA 15-3	kU/L	<30	29	2296	190	2524

ASAT: aspartate amino transferase; ALAT: alanine amino transferase; GGT: gamma-glutamyl transferase; ALP: alkaline phosphatase; LDH: lactate dehydrogenase; CA 15-3: cancer antigen 15-3. Bold values are higher or lower than the normal range of the test.

Table 3. Imaging results of patient cases 1, 2 and 3.

Case	Time point			Description
1.	Before start of therapy			CT-image chest Mass behind the right nipple, 10 × 7 cm Intrapulmonary multiple lung nodules in both lungs, suspect for metastases Intralobular thickening of septa, suspect for lymphangitis carcinomatosis
	After 4 months of therapy			CT-image chest Decrease of primary tumour to 7 × 3 cm Decrease of pulmonary metastases Conclusion: Partial response
2.	Before start of therapy			CT scan image (left), MRI T2 image (right) Multiple nodes in several eye muscles and intra-orbital of both eyes, suspect for intra-orbital metastases
No follow-up scan
3.	Before start of therapy			CT-image chest Mediastinal mass with involvement of the main bronchus right, the bronchus of the right upper lobe, oesophagus and trachea. Diameter 7.6 cm Bilateral multiple pulmonary nodules, suspect for metastases Pleuritis carcinomatosis with pleural laesion of 3.0 cm and pleural effusion at the right side Intralobular thickening of septa, suspect for lymphangitis carcinomatosis Multiple sclerotic bone lesions, with vertebral compression fracture of Th9
	After 3 months of therapy			CT-image chest Decrease of the mediastinal mass, diameter from 7.6 to 6.9 cm Decrease of pulmonary nodules from 1.0 to 0.6 cm Decrease of pleural lesion from 3.0 to 1.6 cm and regression of the pleural effusion Regression of lymphangitis carcinomatosis Conclusion: Stable disease

Data availability statement

Data sharing is not applicable to this case report.