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Publication
Successful management of bilateral orbital metastases from invasive lobular breast cancer with abemaciclib and letrozole: a case report and literature review
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Advisor(s)
Abstract(s)
Breast cancer is a significant global health concern, contributing to substantial
morbidity and mortality among women. Hormone receptor-positive (HR+)/HER2-
negative (HER2-) breast cancer constitutes a considerable proportion of cases, and
significant advancements have been made in its management. CDK4/6 inhibitors
(CDK4/6is) are a new targeted therapy that has demonstrated efficacy in adjuvant,
advanced and metastatic settings. The propensity of lobular breast carcinomas for
estrogen-rich sites, such as periocular tissues and orbital fat, may explain their
tendency for orbital metastases. Current treatment strategies for these cases are
predominantly palliative, and the prognosis remains poor. This article presents a
unique case of a 51-year-old female with progressive right periorbital edema, pain,
and limited ocular motility. An imaging work-up showed bilateral intra and
extraconal orbital infiltration, which was biopsied. The histopathologic analysis
disclosed mild chronic inflammatory infiltrate with thickened fibrous tissue and
moderately differentiated lobular carcinoma cells, positive for GATA3 and CK7
markers, with 100% of tumor nuclei expressing estrogen receptors (ER+). A
systemic evaluation showed a multicentric nodular formation in both breasts.
Further diagnostic assessments unveiled an HR+/HER2- bilateral lobular breast
carcinoma with synchronous bilateral orbital metastases. Systemic treatment was
initiated with abemaciclib 150mg twice daily and letrozole 2.5mg once a day.
However, this regimen was interrupted due to toxicity. After two weeks, treatment
was resumed with a reduced abemaciclib dose (100mg twice daily) alongside
letrozole, with a reasonable tolerance. Nearly two years after the initial diagnosis of
inoperable metastatic cancer, the patient remains on the same systemic treatment
regimen with no signs of invasive disease. This case report is the first of a patientpresenting with bilateral orbital metastases from bilateral lobular breast cancer,
showing an impressive and sustained response to a first-line treatment regimen
combining abemaciclib and letrozole. A literature review on bilateral orbital
metastases from breast cancer is also presented.
Description
Keywords
Carcinoma Ductal de Mama Carcinoma Lobular Neoplasias da Órbita/secundário Letrozol Abemaciclib Carcinoma, Ductal, Breast Carcinoma, Lobular Orbital Neoplasms/secondary Letrozole
Citation
Front Oncol. 202;13:1286910