Antineoplastics

Abstract

Fatigue and lack of efficacy: case report A 67-year-old woman developed fatigue during treatment with rivoceranib for locally advanced triple-negative invasive ductal breast carcinoma (IDBC). Additionally, she exhibited lack of efficacy during treatment with carboplatin, docetaxel, epirubicin, trastuzumab and vinorelbine for breast cancer. The woman was referred to a tertiary hospital in 2018 with a 2-year history of a mass in the right breast and was diagnosed with IDBC. She received five cycles of primary TA chemotherapy regimen comprising docetaxel 120mg and epirubicin 130mg for 21 days in each cycle. However, the tumour grew fiercely with skin ulceration. In December 2018, she presented to current facility with huge hypoechoic mass in the right breast. The pathological results of biopsied specimen of the right breast lump confirmed ER(-), PR(-) and HER-2(-) triple negative IDBC. Thereafter, she received one cycle of TCH regimen comprising docetaxel 110mg D2, carboplatin 550mg D2 and trastuzumab 400mg D1. However, she was refractory to the treatment leading to progressive disease. The FISH analysis confirmed no amplification of the HER2 gene. Therefore, she started receiving further line of NP chemotherapy comprising vinorelbine 36mg D1 and 8 and carboplatin 500mg D1, but have no effect on the tumour. Therefore, she received rivoceranib [Apatinib] 250mg daily from 29 January 2019 to 3 March 2019, resulting in a stable disease. A hypofractionated radiation was delivered to the tumour. Her quality of life was dramatically improved. After radiotherapy, she received rivoceranib 250mg daily for 28 days from 16 March to 12 April 2019. However, the woman discontinued rivoceranib as she could not afford the expense. At 2-month follow-up after radiotherapy, she achieved a near-complete remission. She well-tolerated the treatment. No proteinuria, hypertension, hand-foot syndrome or haematologic toxicities occurred. She developed only mild CTCAE grade 1 fatigue. However, she died due to brain metastasis in August 2019. At that time, chest wall recurrence was also detected.