Late relapse in hormone receptor (+) HER2 (-) early breast cancer: Case report

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Johan Kurnianda
Agus F Achmad



Background: Hormone-receptor (HR) positive breast cancers represent the majority of all breast cancers (BC). Adjuvant endocrine therapy is effective for nearly all women with ER+ and/or PgR+ tumors. Tamoxifen taken for five years has been the standard adjuvant endocrine treatment. However, despite receiving this treatment, >50% ER+ patients relapse and died from breast cancer 5–10 years after diagnosis. 

Case: 50-year-old female with distant relapse BC. November 2008, radical mastectomy of the right breast. Invasive ductal carcinoma grade III T2N1M0 (stage IIb) ER+ (90%), PgR+ (90%), HER2-. Chemotherapy, radiotherapy, and Tamoxifen 2009-2014. Disease-free survival (DFS) : 8 year. January 2017, presented with cough. Chest x-ray: nodule in left lung, transthoracal biopsy: metastatic carcinoma from the breast, ER+ (50%), PgR-, HER2-.

Discussion: Identification of subpopulations likely to benefit from extended endocrine therapy is crucial. For high-risk ER+ patients, ten years endocrine therapy is an option. Evaluation of adverse event, long-term toxicity and risk of recurrence is vital. Discordant hormonal status between primary and metastatic site tumor has been reported 6-40%. Decision to change treatment based on this finding is still limited.


Keywords: late relapse, early breast cancer, hormone receptor positive.

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