Antineoplastics

Abstract

Cancer cachexia: case report A woman in her 50s [exact age at the reaction onset not stated] developed cancer cachexia during treatment with cyclophosphamide, doxorubicin, fluorouracil, toremifene, goserelin, exemestane, fulvestrant, anastrozole, capecitabine and docetaxel for metastatic breast invasive ductal carcinoma [dosages and routes not stated]. The premenopausal woman was diagnosed with breast cancer (at the age of 46 years). In April 2009, she underwent a radical left mastectomy due to the discovery of a mass in the left breast. Postoperative pathology revealed left breast invasive ductal carcinoma. The metastasis classification was found to be pT2N0M0 (IIA phase). Post-operatively, she was scheduled to receive 6 cycles of CAF chemotherapy including doxorubicin, cyclophosphamide and fluorouracil, followed by toremifene. In July 2012, she was admitted to the hospital due to difficulty breathing and chest tightness. After the relevant examination, lung metastasis and multiple metastatic tumours of the thoracic vertebra were considered. In July 2014, she presented with mild oedema of the face and lower limbs. In November 2014, her oedema and chest tightness were aggravated, and metastasis reached the sacrum, ribs, bilateral ilium, bilateral axillary lymph node metastasis and metastasis of the right neck lymph node. She was admitted to the emergency department in January 2015 due to aggravation of chest tightness and oedema of the face and lower limbs. Subsequently, she started receiving chemotherapy with goserelin and exemestane in 2015. The examination over the following 10 months revealed no tumour progression. Her quality of life also improved significantly. In November 2015, she was admitted to the hospital after finding a mass in her right neck, pain in her lower back and dysuria. The further examination revealed metastatic nodules and bone metastases. After the disease progression, lumbosacral local radiotherapy was administered along with anastrozole. However, disease progression was again noted on 22 December 2015. Therefore, she was scheduled to receive 6 cycles of chemotherapy with capecitabine and docetaxel. Later, tumour markers showed a declining trend. As stable disease was evaluated, capecitabine monotherapy was maintained. In October 2016, she was admitted to the hospital due to an aggravation of migraine lasting for one week. In February 2017 (in her 50s), she was admitted to the hospital due to weakness of the lower right limb and night sweats along with lumbar discomfort. The positron emission tomography-computed tomography revealed a large amount of pleural effusion on the right side. It was also noted that the vertebral body was involved in a larger range. Therefore, she received treatment with fulvestrant. Her course of illness was notable by significant weight loss. The woman underwent thoracic laminectomy and pedicle screw fixation in March 2017 due to pain and numbness in her left lower limb. She additionally underwent tumour resection. On 23 July 2018, she was admitted to the hospital. On admission, she weighed only 50kg. Based on the clinical presentation and laboratory findings, cancer cachexia secondary to the chemotherapy (cyclophosphamide, doxorubicin, fluorouracil, toremifene, goserelin, exemestane, fulvestrant, anastrozole, capecitabine and docetaxel) was considered. Subsequently, she died due to multiple organ failure.