Excellent response to gemcitabine in a massively pre-treated woman with extensive cutaneous involvement after recurrence of breast cancer

A 50-year-old woman presented with local relapse of breast cancer 6 years a fter partial mastectomy. Relapse was accompanied by extended skin induratio n due to tumor cell embolization of dermal lymphatics. During the following years the patient was exposed to 11 different anti-tumor regimens includin g 13 cytotoxic drugs (including alkylating agents, antitumor antibiotics, v inca alcaloids, epipodophyllotoxins, and taxanes), 4 anti-hormonal, and 2 i mmunologic attempts. Paclitaxel achieved a prolonged local improvement for some 7 months, but further various treatments were ineffective. At that tim e gemcitabine therapy was initiated and tumor infiltration of the skin was visibly diminished only 2 weeks later. After that tumor regressed further f or 5 months and remained stable with continued doses of gemcitabine during much of the woman's last year. The patient died of acute myeloid leukemia ( AML) 4 years after the local recurrence of breast cancer. Since multiple tr eatments using a plethora of aggressive cytotoxic drugs may render several classes of chemotherapy agents ineffective due to cross-resistance, it seem s advisable to select mild agents that are not subject to multidrug resista nce mechanisms and display a unique mode of action as demonstrated in this case by gemcitabine.