Loading
Cancer Diagnosis and Treatment / Nonmelanoma Skin Cancer Studies · Journal article
Medicine · August 14, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a case report of a 53-year-old woman with HER2-positive breast cancer who developed cutaneous metastases with phenotypic conversion to triple-negative subtype, treated with gemcitabine–cisplatin–envafolimab followed by vinorelbine–bevacizumab–envafolimab. The case illustrates the clinical challenge of phenotypic conversion and supports the practice of re-biopsy at metastatic sites, but does not provide evidence sufficient to evaluate treatment efficacy.
Case report. A 53-year-old female who underwent right modified radical mastectomy for HER2-positive invasive breast carcinoma in September 2023 and developed cutaneous metastases 9 months later.. Intervention: Gemcitabine plus cisplatin combined with envafolimab (6 cycles, August–November 2024), then switched to vinorelbine plus bevacizumab combined with envafolimab (January 2025 onwards).
Primary tumor was HER2 (3+) with ypT2N3aMx, 23/23 positive nodes, grade 3, Ki-67 ~40% Supraclavicular lymph node biopsy (October 2023) showed HER2 IHC 0, first evidence of phenotypic conversion Cutaneous metastatic biopsy (July 2024) confirmed triple-negative phenotype: ER(-), PR(-), HER2 IHC 0, Ki-67 ~60%+
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
This case emphasizes the importance of re-biopsy in metastatic disease to detect phenotypic conversion and guide therapeutic strategy changes. Clinicians should be alert to potential conversion to triple-negative disease in HER2-positive breast cancers, even when the primary tumor was hormone receptor-negative.
A single case report documenting an unusual clinical phenomenon (phenotypic conversion in breast cancer metastasis) with descriptive pathology and treatment response, insufficient to establish efficacy or guide practice.
As stated by the source record.
Quoted from the source exactly as published.
This case emphasizes the importance of re-biopsy in metastatic disease to detect phenotypic conversion and guide therapeutic strategy changes. Clinicians should be alert to potential conversion to triple-negative disease in HER2-positive breast cancers, even when the primary tumor was hormone receptor-negative.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Rationale: Cutaneous breast cancer metastasis carries poor prognosis. Phenotypic conversion to a triple-negative subtype presents therapeutic challenges. Re-biopsy is crucial. Patient concerns: A 53-year-old female underwent right modified radical mastectomy for HER2-positive invasive breast carcinoma in September 2023, and developed pruritic, erythematous nodules on the right chest wall, axilla, and back 9 months later. Diagnoses: Histopathology revealed poorly differentiated dermal carcinoma. The primary tumor was ypT2N3aMx with 23/23 positive nodes, grade 3. IHC showed ER(-), PR(-), HER2 (3+), and Ki-67 (~40%). In October 2023, a supraclavicular lymph node biopsy revealed HER2 IHC 0, representing the first evidence of phenotypic conversion. In July 2024, biopsy of the cutaneous metastatic lesion confirmed HER2 IHC 0 (no membrane staining), ER(-), PR(-), and Ki-67 (~60%+), consistent with a persistent triple-negative phenotype. Interventions: Treatment was switched to gemcitabine plus cisplatin combined with envafolimab (a PD-L1 inhibitor). Prior to initiation, PD-L1 IHC (SP263, Ventana) revealed TC 0%, IC+ <1%, and ICP ~10%. Six cycles were administered between August and November 2024. In January 2025, new lesions with ER 20% positivity emerged, and the regimen was adjusted to vinorelbine plus bevacizumab combined with envafolimab. Outcomes: The patient completed 6 cycles of gemcitabine plus cisplatin combined with envafolimab. Course was uneventful, with isolated grade 3 neutropenia (0.71 × 10^9/L) in October 2024. In January 2025, new cutaneous lesions emerged, prompting biopsy and regimen change. As of April 2025, the patient remained on active treatment with stable disease status. Lessons: This case underlines re-biopsy importance. Conversion to a triple-negative phenotype necessitates complete change in systemic therapy. Phenotypic conversion may first manifest in lymph node metastases before becoming clinically evident in cutaneous lesions.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.