Modifying disease therapy in multiple sclerosis and breast cancer: case report

Address for correspondence: Felipe Nascimento (email: [e-mail]).

Abstract

Case Presentation: We herein report the cases of three female patients diagnosed with relapsing-remitting multiple sclerosis (RRMS) undergoing therapy with high-efficacy drugs, including natalizumab, ocrelizumab, and fingolimod. During treatment, they were diagnosed with breast nodules (BNs) and initially chose clinical monitoring. The first patient, aged 36 years, had been monitoring a BN with a specialist since 2018, starting ocrelizumab treatment. After three months, she was diagnosed with breast cancer. The second patient, aged 45 years, had been following a BN with a specialist since 2015, starting Fingolimod in 2018, and undergoing a breast biopsy that year, which revealed ductal hyperplasia. After partial breast resection in 2019, she relapsed, switching to natalizumab and experiencing cancer recurrence. The third patient, aged 38 years, rejected the conventional treatment, and opted for high-dose vitamin D therapy despite medical recommendations for disease-modifying drugs (DMD). Due to new relapses and increased lesion burden, she started natalizumab, and was later diagnosed with ductal carcinoma in situ, leading to bilateral mastectomy.

Discussion: Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system that affects young women globally and is altered by disease-modifying therapy (DMT). Despite the proven efficacy, recent studies have suggested potential adverse effects, including neoplasms such as breast cancer. Many patients already have BNs before the DMT, due to lack of regular screening. Breast cancer is prevalent among women worldwide, and its diagnosis may result from disease progression or missed screening. Three patients with prior breast nodule follow-up, diagnosed with RRMS and on high-efficacy therapy, are herein presented, two with malignant breast neoplasia.

Final Comments: Although breast neoplasia occurred in the three patients, causality with disease-modifying drugs cannot be established. Further research is needed to understand their potential adverse effects. Implementing neoplasm screening protocols for patients on DMT is crucial.

 

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Publikationsverlauf

Artikel online veröffentlicht:
02. Oktober 2024