In 2000, at the age of 47, she underwent a mastectomy for stage IIIB (T4a N1) infiltrating ductal carcinoma of the breast. Hormone receptors were positive, as was Herceptest (+++). She received complementary treatment with chemotherapy (CMF), radiotherapy and tamoxifen. In May 2003 a cervical bone recurrence was detected causing spinal cord involvement. She was treated with surgery and local radiotherapy. Subsequently she started treatment with letrozole. In November 2003, bone and lymph node (supraclavicular) tumour progression was confirmed. She then started palliative cytostatic treatment with epirubicin, docetaxel and trastuzumab. In the following weeks she presented a significant but transient symptomatic worsening; the evolution of these symptoms is described in the patient's own notes, which she later provided us with. At the same time, CA153 and alkaline phosphatase levels were elevated and subsequently decreased to normal (Figure 1). Clinically, bone scan uptake did not change significantly but supraclavicular adenopathy achieved a complete response. The duration of the response was ten months, after which he presented bone and liver progression. He is currently receiving a new line of chemotherapy with apparent stabilisation of the disease.

