Cryoablation as the primary treatment in a HER2 positive Stage IV breast cancer patient: 5 years term follow up case report

We report a case of human epidermal growth factor receptor 2 (HER2)+ Stage IV breast cancer with metastatic lung cancer treated with cryoablation as a first line treatment. The patient, a 34 year old woman voluntarily screened for breast cancer, was referred to our clinic after a mammogram revealed calcification findings. The patient had a tumor in the right breast and lung metastasis. The tumor was 34×31×23 mm with internal heterogeneity in the right mammary gland. Imaging and vacuum-assisted breast tumor biopsy led to a diagnosis of invasive ductal carcinoma (estrogen receptor positive, progesterone receptor negative, and human epidermal growth factor receptor 2 positive). The patient received 6 cycles of trastuzumab, and paclitaxel, followed by 11 cycles of trastuzumab, pertuzumab, and Tamoxifen as pre-cryoablation adjuvant therapy. After chemotherapy, the patient underwent minimally invasive cryoablation treatment followed by fractionated radiation therapy to the entire right breast. In the last follow up, 5 years following cryoablation as a first line treatment after anti-HER2 therapy, a complete local response was recognized, with no evidence of disease progression in the lung metastasis or recurrence of the primary breast tumor. This case report demonstrates that cryoablation is safe and effective, with favorable cosmetic results also for late stage breast cancer. Cryoablation, as a minimally invasive treatment for primary site control of Stage IV breast cancer, can provide a good alternative that preserves the quality of life. It can be performed under local anesthesia and be performed jointly with chemotherapy, radiation therapy, surgery, and immunotherapy.