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(A) Red arrows show lung metastases at baseline and (B) after 12 weeks of therapy with ribociclib.
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Baseline laboratory parameters: cancer antigen (CA) 15-3 was 285.1 U/mL (0.0-30.0 U/mL) (Figure S1), carcinoembryonic antigen (CEA) of 24.1 ng/mL (0.0-5.0 ng/mL) (Figure S2), WBC count of 8.10 K/microL, hemoglobin of 14.9 g/dL, platelet count of 249 K/microL, and complete metabolic panel was normal. The CT scan showed partial pulmonary (lung metastasis to right upper lobe 13 x 11 vs 16 x 12 mm) and hepatic response (metastasis to eighth hepatic segment 15 x 13 vs 19 mm) (Figure 1A and B, Figure 2A and B) and stable bone and brain disease.
(A) Red arrows show liver metastases at baseline and (B) after 12 weeks of therapy with ribociclib.
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Baseline laboratory parameters: cancer antigen (CA) 15-3 was 285.1 U/mL (0.0-30.0 U/mL) (Figure S1), carcinoembryonic antigen (CEA) of 24.1 ng/mL (0.0-5.0 ng/mL) (Figure S2), WBC count of 8.10 K/microL, hemoglobin of 14.9 g/dL, platelet count of 249 K/microL, and complete metabolic panel was normal. The CT scan showed partial pulmonary (lung metastasis to right upper lobe 13 x 11 vs 16 x 12 mm) and hepatic response (metastasis to eighth hepatic segment 15 x 13 vs 19 mm) (Figure 1A and B, Figure 2A and B) and stable bone and brain disease.
(A) Red arrows show lung metastases at baseline and (B) after 10 cycles of therapy with ribociclib.
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The biopsy revealed infiltrating carcinoma, ER (95%), PR (90%), Ki-67 (60%), HER2 (1-positive not overexpressed/negative) (Figure S3).
(A) Red arrows show liver metastases at baseline and (B) after 10 cycles of therapy with ribociclib.
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By August 2018, after 10 cycles of therapy, the revaluation CT scan showed further reduction of lung (lung metastasis to the right upper lobe 11 x 6 vs 16 x 12 mm) and liver metastases (metastasis to the eighth hepatic segment 12 x 9 vs 19 mm and to the fifth hepatic segment 13 vs 15 mm) (Figure 3A and B, Figure 4A and B).
(A) Red arrows show brain metastases at baseline and (B) after 10 cycles of therapy with ribociclib.
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The same CT scan showed an increase in size of the right occipital metastasis (22 vs 5 mm) (Figure 5A and B).
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(A) Hepatic complete response and (B) stable brain disease after 31 months of therapy with ribociclib.
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In July 2020 after 31 months of therapy, CT scan showed complete hepatic response and stable disease in other sites (Figure 6A and B).
(A) and (B) Red arrows show liver metastases after 49 months of therapy with ribociclib.
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In February 2021, after 3 years and 2 months of therapy, CT scan showed hepatic progression of disease (Figure 7A and B).
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First CT scan evaluation. (A) Red arrows in the figures show sternum lytic metastasis, (B) lung metastasis of 30 mm diameter, (C) mediastinal lymph node of 30 mm diameter and right breast tumor, and (D) axillary lymph node.
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A highly suspicious metastatic lesion was observed in some right axillary and mediastinal lymphadenopathies, lung, and bone (sternum and right hemisome of D8) (Figure 8A-D).
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CT scan evaluation after treatment. (A) Red arrows in the figures show sternum lytic metastasis, (B) mediastinal lymph node, (C) axillary lymph node, and (D) lung metastasis.
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As per the CT scan evaluation (April 2020), partial response in breast was observed, lymph nodes were maintained, skeletal disease was stable, and the pulmonary nodule was hardly recognizable (Figure 9A-D).
PET FDG evaluation.
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Disease re-evaluations with positron emission tomography fluorodeoxyglucose (PET FDG) evaluations (August 2020 and January 2021) showed a low hypermetabolism in the breast localization (SUV max 3.2) and no pathological uptake in the lung, lymph node, and skeletal sites (Figure 10).
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CT scan with bone windows. (A) Humerus shows a lytic lesion into the posterior humeral head, the cortical part of the humerus head is conserved, (B) area of osteosclerosis into the previous lytic lesion, as response to treatment, (C) further osteosclerosis area in relation to the partial recalcification of the lesion.
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After 11 months of treatment, CT scan showed disappearance of the known lymph nodes, stability of adrenal gland lesions, and an important response of the left humerus lytic metastasis (Figure 11B). After 25 months, the humerus lesion showed healing (Figure 11C) and stabilization of the other lesions.
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CT scan with bone windows. (A) Humerus shows a lytic lesion into the posterior humeral head, the cortical part of the humerus head is conserved, (B) area of osteosclerosis into the previous lytic lesion, as response to treatment, (C) further osteosclerosis area in relation to the partial recalcification of the lesion.
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After 11 months of treatment, CT scan showed disappearance of the known lymph nodes, stability of adrenal gland lesions, and an important response of the left humerus lytic metastasis (Figure 11B). After 25 months, the humerus lesion showed healing (Figure 11C) and stabilization of the other lesions.
PMC9576937_10
(A) Red arrows show lung metastases at baseline and (B) after 10 cycles of therapy with ribociclib.
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The biopsy revealed infiltrating carcinoma, ER (95%), PR (90%), Ki-67 (60%), HER2 (1-positive not overexpressed/negative) (Figure S3).
(A-D and G-J) CT scan of bone, lymph node, lung; (E and F) follow-up CT scan lung and lymph node.
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Follow-up CT scan in October 2017 showed reduction of all pulmonary and lymph nodal metastases (Figure 12E and F). CT scan showed stable disease until the last examination in October 2021 (Figure 12G-J).
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(A-D and G-J) CT scan of bone, lymph node, lung; (E and F) follow-up CT scan lung and lymph node.
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Follow-up CT scan in October 2017 showed reduction of all pulmonary and lymph nodal metastases (Figure 12E and F). CT scan showed stable disease until the last examination in October 2021 (Figure 12G-J).