Application of neoadjuvant chemotherapy combined with anlotinib in occult breast cancer: A case report and review of literature

Metastatic lymph nodes of occult breast cancer show very low internal echoes

A 62-year-old woman showed an elevation of carcinoembryonic antigen (CEA) level 15 years after the left breast cancer, i.e., tubule forming type luminal micro invasive cancer, operation. Positron emission tomography/computed tomography (PET/CT) showed avid radio-tracer uptake in her right axillary and supraclavicular lymph nodes. Mammography, ultrasound (US), PET/CT, and magnetic resonance imaging showed no abnormalities in her right breast. US of the enlarged lymph nodes showed very low internal echoes. Pathological study using a core needle biopsy specimen of a right axillary node showed human epidermal growth factor receptor type 2 (HER2) positive atypical cells growing in solid and trabecular fashions. Under the presumed diagnosis of right occult breast cancer, the patient received anti-HER2 agents-containing chemotherapy, leading to marked shrinkage of the enlarged lymph nodes with normalization of the elevated CEA level. To confirm the pathological efficacy, sentinel plus sampling node biopsy was done to the patient. Postoperative pathological study of the resected nodes showed fibrosis and no viable cancer cells. The patient further received radiotherapy both to the right breast and suprarclavicular region followed by adjuvant anti-HER2 agents therapy, and has been well without any recurrences for 39 months. Diagnostic physicians should note that metastatic lymph nodes of occult breast cancer show very low internal echoes.

Anlotinib inhibits the proliferation, migration and invasion, and induces apoptosis of breast cancer cells by downregulating TFAP2C

The vascular endothelial growth factor receptor (VEGFR) network contributes to breast cancer pathogenesis and progression. Anlotinib is a highly potent multi-target tyrosine kinase inhibitor that has been previously shown to exert antitumor effects in various types of cancer. The aim of the present study is to investigate the effect of Anlotinib against breast cancer cells in vitro and uncover the possible underlying mechanisms. The human breast cancer cell line MCF-7 was treated with different concentrations of Anlotinib, before cell proliferation, migration, invasion and apoptosis were assessed using colony formation, wound healing, Transwell and TUNEL staining assays. In addition, the expression of transcription factor AP-2γ (TFAP2C) following Anlotinib stimulation was measured using reverse transcription-quantitative PCR and western blot analysis. TFAP2C was overexpressed in MCF-7 using transfection with a pcDNA3.1 vector, before the aforementioned experiments were repeated. The results revealed that Anlotinib impaired cell viability and colony formation, reduced proliferating cell nuclear antigen, Ki-67, MMP2, MMP9 and Bcl-2 expression levels, and inhibited cell migration and invasion. By contrast, the expression levels of tissue inhibitor of metalloproteinase 1, the frequency of apoptotic cells, the expression of Bax and the cleaved caspase-3/caspase-3 ratio increased in a concentration-dependent manner. Additionally, the expression of TFAP2C decreased after Anlotinib treatment. However, TFAP2C overexpression partially blocked the effects of Anlotinib on the proliferation, migration, invasion and apoptosis of MCF-7 cells. To conclude, Anlotinib suppressed proliferation, migration and invasion, whilst inducing apoptosis of MCF-7 cells, which may be partially dependent on the inhibition of TFAP2C expression.