Surviving metastatic breast cancer for 18 years: A case report and review of the literature

We report a case of a 93-year-old woman who was diagnosed with estrogen receptor (ER)-positive, progesterone receptor-positive, T2N0M0 (stage I) breast cancer (BC) at the age of 45. Twenty-two years later, she was diagnosed with metastatic lesions to the lungs consistent with the breast primary. Her disease was stable on tamoxifen, anastrozole, and exemestane for 14 years. Subsequently, she was found to have metastatic lesions to thoracic spine as well as progressively increasing bilateral pleural effusions. At that time, she was deemed not to be a good candidate for chemotherapy and therapy was changed to fulvestrant. Two years later (38 years after initial diagnosis of BC), she was diagnosed with new metastatic liver lesions; although her pulmonary and bone metastases remained stable. Therefore, she was started on palliative chemotherapy with single-agent capecitabine. The treatment was discontinued after the second cycle upon the patient's request owing to grade 2 hand and foot syndrome. She expired 2 years later after fighting BC for four decades. She survived for 18 years after the diagnosis of metastatic breast cancer (MBC) while maintaining a good quality of life. To the authors' knowledge, this is the first reported case in the literature with the longest overall survival in a patient with MBC. We provide a detailed clinical analysis in conjunction with a brief literature review.