Major response to sunitinib (Sutene®) in metastatic malignant phyllodes tumor of breast

Excerpt

A 59-year-old woman underwent partial resection of the left breast for malignant phyllodes tumor in September 2007. Three months later, the tumor recurred at the original site which required total mastectomy. There was no evidence of distant metastasis. The mass measured 7.5 × 7.0 × 5 cm. The deep resection margin was involved and all 13 axillary lymph nodes were negative for tumor metastasis. It was high-grade malignant phyllodes tumor with a heterogenous chondrosarcoma component. Immunohistochemical staining of the tumor was diffusely positive for VEGF and focally positive for c-kit (Fig. 1). Postoperatively, the patient received radiation to the tumor bed at a dose of 6,000 cGy in 30 fractions. Subsequent computed tomography (CT) of the chest showed multiple metastatic nodules in both lung fields within 3 months. Sunitinib (Sutene®), 37.5 mg once per day for 2 weeks, and intravenous paclitaxel, 80 mg/m² on days 1 and 8 every 3 weeks were initiated. After two cycles of therapy, repeated chest CT revealed a marked tumor response (Fig. 2). The masses measured 18.46 cm in sum at baseline and 6.30 cm in sum after two cycles of treatment consistent with a partial response according to the RECIST criteria. The patient remained free of symptoms. After the fourth cycle, chest CT showed further tumor reduction.

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