Goserelin plus endocrine treatments maintained long-term clinical benefit in a male patient with advanced breast cancer
Department of Breast Oncology, 307 Hospital of PLA
Background: Goserelin plus aromatase inhibitors (AI) have already been used in male advanced breast cancer, but the cases that fulvestrantin male breast cancer are rare. Case presentation: Here we report a case of long-term (3 years) response to Goserelin plus continuing endocrine treatments given for a male advanced breast cancer. The patient prolongs his life with high life quality, and has more time with his family. Conclusion: Goserelin plus endocrine treatments may benefit male breast cancer.
Breast cancer in men is relatively rare, and most breast
cancers in men are estrogen receptor/progesterone
receptor positive. Tamoxifen remains the standard adjuvant
treatment and is also the mainstay first-line treatment for
advanced disease. However, the role of AI and fulvestrant
remains controversial. We have already used goserelin
plus aromatase inhibitors (AI) in male advanced breast
cancer, but the cases in which fulvestrant has been used in
male breast cancer are rare.
A 44-year-old man was diagnosed with a left breast cancer
(pT1N1M0) after left modified radical mastectomy in local
hospital. The tumor was ER-positive, PgR-negative, and
HER-2-negative as evaluated by immunohistochemistry.
The patient received CAF(Cytoxan+doxorubicin+5-Fu)
adjuvant chemotherapy with six cycles, and tamoxifen was
administered for 3 years. In 2008, metastasis was found in the
sternum and scapula by skeleton ECT(emission computed
tomography) scan. Sternum dissection was carried out
followed by radiotherapy (60 Gy total dose), and two cycles
of chemotherapy with docetaxel and cisplatin were given,
followed by four cycles of docetaxel and capecitabine, and
monthly Zoledronic acid. Letrozole was started as the
firstline endocrine treatment, but discontinued after 7 months
because of disease progression.
In October 2009, the patient went to our hospital and
was diagnosed with multiple bone and lung metastases on
chest computed tomography (CT). He received Goserelin
plus anastrozole as a second-line endocrine treatment,
which resulted in stable disease for 12 months prior to
progression. Goserelin plus exemestanewas started as a
third-line endocrine treatment, which also resulted in
stable disease for 11 months. He received 10 months of
medroxyprogesterone prior to further progression of lung
disease. In August 2012, Goserelin plus fulvestrant(500
mg/d,1,250 mg intramuscular monthly)was initiated as the
fifth-line endocrine treatment. The lung metastasis shrank
after 2 months and the patient is still on treatment.
Detailed treatment information is given Table 1.
Male breast cancer is rare, accounting for 1% of all breast
cancer, and is also rare in male malignant tumors. Endocrine
treatments are important in hormone-receptor-positive
male breast cancer. Tamoxifen remains the gold-standard
adjuvant treatment. Anastrozole, letrozolea and
exemestane as AI can inhibit the action of the enzyme aromatase,
which converts androgens into estrogens by a process
called aromatization, therefore are used in the treatment
2014 Jiang et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative
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TTP = 2 months
TTP = 4 months
TTP = 7 months
TTP = 12 months
TTP = 11 months
TTP = 10 months
Table 1 Patients treatment after metastasis
Start and stop time, year/month
Sites of metastasis
2008/8 to 2008/10
2008/10 to 2008/12
2009/3 to 2009/10
2009/10 to 2010/10
2010/10 to 2011/9
Docetaxel + cisplatin
Docetaxel + capecitabine
Goserelin + anastrozole
Goserelin + exemestane
Goserelin + fulvestrant
SD stable disease, TTP time to progression.
of breast cancer. Goserelin is an injectable
gonadotropinreleasing hormone superagonist, also known as a
luteinizing hormone-releasing hormone (LHRH)
agonist, and is used to suppress production of the sex
hormones (testosterone and estrogen). For male breast
cancer, goserelin,which suppresses production of
testosterone, may be better for the effect of AI.
Medroxyprogesterone is a potent full agonist of the AR
(androgen receptor) by hypothalamus pituitary adrenal
axis suppression. Its activation of the AR has been
shown to play an important and major role in its
antigonadotropic effects and in its beneficial effects against
breast cancer. This patient was treated with goserelin
plus AI and maintained long-term clinical benefit. To
date there has been little clinical study onthe
subsequent treatment after disease progression following AI
treatment for male breast cancer.
Fulvestrant is novel steroidal ER antagonist lacking
agonist effects. By covalent binding to the ER, receptors
are rapidly downregulated, resulting in a decrease of
cellular ER levels and complete abrogation of
estrogensensitive gene transcription .In postmenopausal
women, fulvestrant has been shown to be effective and
safe in patients in whom tamoxifen or AI have failed
. At present, some clinical studies of fulvestrant used
in male breast cancer have been reported . However,
endocrine treatment with Goserelin plus fulvestrant for
male breast cancer has not been reported in the
literature so far. Our patient is a 44-year-old man, so
we thought Goserelin,which suppresses production of
testosterone may be beneficial with fulvestrant. He has
hormone-dependent breast cancer, and sustainable
endocrine treatments have achieved long-lasting
clinical benefit (3 years).
Since 2009, the patient was under easy endocrine
treatments, with good tolerability, avoiding adverse
effects of chemotherapy, and improved quality of life. He
had more time with his family and work in society.Our
oncologist proposes that the treatment for advanced
breast cancer should prolong survival, maintain quality
of life, and make the patient happy.
For male hormone-positive breast cancer goserelin plus
AI or fulvestrant maybe good choices, especially the
patient is hormone-sensitive.
The authors declare that they have no competing interests.
JH wrote the report, revised and submitted the manuscript for publication.
WT helped to gather the patients information and revised the manuscript.
JZF helped with editing the report. Both authors read and approved the final
Wang Tao (307 hospital) helped to gather the patients information.