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There is no effective treatment for metastatic cutaneous apocrine carcinoma (CAC). In some cases of CAC, human epidermal growth factor receptor 2 (HER2) is overexpressed.1,2 We report the case of a patient with metastatic CAC for whom a combination of the anti-HER2 humanized monoclonal antibodies with taxane chemotherapy was effective.
A man in his 50s presented with an asymptomatic erythematous tumor and lymph nodes fused with the right chest wall, axillary artery, and vein of the right axilla. (Figure 1A). A skin biopsy performed from a specimen of the axilla revealed that atypical tumor cells had proliferated in the dermis to the subcutis (Figure 2A). Immunohistochemically, these tumor cells were positive for gross cystic disease fluid protein 15 and HER2 (immunohistochemical score of 3+) (Figure 2B and C) and negative for mammaglobin and estrogen and progesterone receptors. From these findings, we diagnosed the tumor as CAC. Computed tomography (CT) revealed fused lymph nodes in the right axilla, which infiltrated the right chest wall, axillary artery, and vein. The CT findings enabled us to determine that there was no surgical indication. Therefore, considering that the tumor cells strongly expressed HER2, we administered the combination of pertuzumab and trastuzumab, which are HER2 inhibitors, with taxane chemotherapy according to the treatment of HER2-positive metastatic breast cancer (MBC).3-5 These drugs were intravenously administered every 3 weeks. Pertuzumab and trastuzumab were administered at fixed dosages of 420 mg and 6 mg/kg, respectively, and docetaxel was administered at a dosage of 75 mg/m2. After 7 cycles of this combination therapy, erythematous lesions and fused lymph nodes dramatically decreased (Figure 1B). At this point, we determined that it was possible for the patient to undergo surgical treatment. We performed a wide local excision of the primary lesion and regional lymph node dissection, and the defect was reconstructed using the latissimus dorsi musculocutaneous flap (Figure 1C). Pathological results showed that there were viable tumor cells in dissected lymph nodes; however, the accessory mammary gland was not identified. Additional radiotherapy was administered on the right axilla with a total dose of 60 Gy, and subsequent trastuzumab monotherapy was administered. Following 11 cycles of this monotherapy, CT showed complete response (CR). At the last follow-up, 11 months after surgical treatment, the patient was disease free.
Otsuka M, Yamasaki O, Kaji T, Shien T, Iwatsuki K. Metastatic Cutaneous Apocrine Adenocarcinoma Treated With a Combination of Pertuzumab-Based Targeted Therapy and Taxane Chemotherapy: A Case Report. JAMA Dermatol. 2016;152(1):111–113. doi:https://doi.org/10.1001/jamadermatol.2015.2507
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