Case report review of VMAT, utidelone, and denosumab in a breast cancer patient with clivus metastasis

Breast cancer stands as the most prevalent malignant tumor among women globally and is a significant contributor to cancer-related mortality. The distant metastasis sites of breast cancer patients were mainly the lung, liver and bone. Clivus metastasis of breast cancer is extremely rare and has been reported only in case reports. The early symptoms associated with this type of metastasis are insidious, making detection during routine examination challenging for patients with breast cancer. Previous reports indicate that the median survival for patients with clivus metastasis was only 9.4 months, and there is a lack of unified treatment standards. Some patients develop drug resistance after multiline treatment, presenting significant therapeutic challenges. In this case report, for the rare refractory disease of breast cancer with clivus metastasis, the whole course treatment mode of volumetric modulated arc therapy (VMAT) combined with concurrent chemotherapy with utidelone, followed by long-term maintenance of denosumab, was adopted. Over a follow-up period of 30 months, no recurrence was observed. This regimen combines local lesion control with high-dose radiotherapy and systemic chemotherapy with a novel epirubicin microtubule stabilizer, utidelone. Denosumab, which is used for maintenance therapy after concurrent chemoradiotherapy, is valuable for both bone protection and tumor microenvironment regulation and ultimately achieves rapid and durable clinical remission. This report provides a reference for the treatment of similar rare metastatic cases and provides important preliminary evidence for follow-up clinical research.