The patient is a 42-year-old female of white race and Arab ethnicity diagnosed with metastatic right breast cancer (invasive mammary carcinoma) that has spread to her lymph nodes and bones. She presented with a 3 cm palpable mass, pain, fatigue, and weight loss in the upper outer quadrant of her right breast, which was also detected through mammography to have spiculated and irregular borders. Her lymph nodes in the right axillary region were firm and rubbery, no previous medical history but has a positive family history of hormonal breast cancer. Treatment plans include chemotherapy, radiation therapy, and hormonal therapy.
Clinical findings timeline:
The patient, a 42-year-old premenopausal woman with a positive family history of breast cancer (her mother), was diagnosed with triple-negative breast cancer (TNBC) in the right breast on August 30, 2022. A mammogram and ultrasound were performed on the same day, revealing a right upper quadrant asymmetry and a retro areolar thickening mass classified as BIRADS 5. The ultrasound showed infiltration of the surrounding parenchyma and metastatic lymph nodes. Figure 1 Core biopsy confirmed invasive ductal carcinoma GII with positive vascular invasion, negative estrogen receptor (ER), negative progesterone receptor (PR), and Her2/neu score 1+ negative on September 5, 2022. Figure 2
A metastatic workup was conducted on September 6, 2022, including a PET/CT scan, which showed an ill-defined infiltrative lesion in the right breast, axillary lymph node metastasis, and no clinical evidence of metastasis in the brain, neck, chest, abdomen, or pelvis.
On March 12, 2023, combined digital tomosynthesis, mammography, and breast sonography revealed a spiculated mass in the right breast with suspicious segmental calcifications. The patient underwent four cycles of Adriamycin and cyclophosphamide followed by 12 chemotherapy short courses with paclitaxel and carboplatin. However, on April 1, 2023, the tumor size returned to its original size, and aggressive recurrence occurred, causing concerns for the patient.
On April 30, 2023, the patient underwent a modified radical mastectomy with axillary clearance. Histopathological examination of the resected specimens revealed invasive ductal carcinoma, grade 3, with negative ER, negative PR, and Her2/neu negative (score 0).
On June 25, 2023, the patient experienced right leg pain, leading to a bone scan that revealed osseous metastasis in multiple areas, including the right iliac bone, head and trochanteric area of the right femur, right ischium left acetabulum, and trochanteric area of the left femur. Figure 3
Facing the reality of bone metastasis and fearing the future, the patient sought information and support through websites, social media, and support groups. During her research, she came across information about glucosodiene as a potential treatment targeting metabolic pathways.
Therapeutic interventions:
Starting from July 15, 2023, the patient began taking glucosodiene as an oral supplement (100 ml) once daily at 9 pm for 15 days. Additionally, the patient adopted a low-carbohydrate diet, focusing on vegetables, proteins, and fats. After the fifth day of treatment, the patient experienced improvement and was able to walk, alleviating the severe pain in both legs following the mastectomy.
On July 27, 2023, an isotopic bone scan with dual-phase bone scintigraphy showed stable tracer uptake in the previously identified areas, with mild hyperemic changes during the blood pool phase. The rest of the skeleton displayed homogeneous tracer distribution without active or cold focal lesions. Follow-up bone scans were recommended. Figure 4
A DEXA scan was performed on July 30, 2023, to assess the patient's bone density. The results indicated low bone density and an osteoporosis diagnosis, with the left femur showing the lowest bone mineral density (BMD) measurement. The patient's fracture risk was deemed high, and treatment initiation or adjustment was recommended. Follow-up examinations after completing the treatment were advised to monitor the effectiveness of the treatment and the patient's bone health status, based on the World Health Organization (WHO) guidelines. Figure 5
On August 9, 2023, MRI was revealed no suspicious osseous lesions in the pelvic bone. while there were notable findings related to bilateral old developmental dysplasia of the hips (DDH) as from history taking this patient suffer from congenital hip dislocation from birth. The left hip showed complete dislocation, while the right hip displayed marked lateral subluxation. Additionally, the right hip exhibited secondary degenerative osteoarthrosis, characterized by a flattened femoral head, subarticular sclerosis, cysts, and marrow edema. Degenerative changes were also observed at the left femoral head, along with pseudoarthrosis with the iliac bone. Furthermore, there were bilateral mild hip effusion and left iliopsoas bursitis. In summary, the report of MRI indicated no suspicious osseous lesions in the pelvic bone but confirmed bilateral chronic DDH with secondary degenerative changes. [ Figure 6]
Vital indicators prior to treatment
Based on the results, the patient underwent medical tests (liver, kidney, heart, pancreas, blood, blood pH, and urine) before the treatment with glucosodiene on July 15, 2023. The liver function tests showed ASGOT (Aspartate Aminotransferase) levels of 26 U/L (Reference Range: Up to 40 U/L) and ASGPT (Alanine Aminotransferase) levels of 22 U/L (Reference Range: Up to 45 U/L).
The kidney function tests revealed a serum creatinine level of 0.75 mg/dL (Normal: 0.6-1.4 mg/dL) and a blood urea level of 34 mg/dL (Normal: 15-45 mg/dL). The cardiac marker, ALDH (Lactate Dehydrogenase), was measured at 393 U/L (Normal: 230-460 U/L). In the hematology report, the patient had a hemoglobin level of 12.8 g/dL (Reference Range: 11.7-15.5 g/dL), a red blood cell count of 4.45 x 10³ Cells/μL (Reference Range: 3.8-5.1 x 10³ Cells/μL), and a hematocrit level of 42.6% (Reference Range: 35-45%). The platelet count was 181 x 10³/mm³ (Reference Range: 150-440 x 10³/mm³), and the white blood cell count was 8.93 x 10³/mm³ (Reference Range: 4.5-11.0 x 10³/mm³). The urine examination showed normal physical properties, including random volume, amber-yellow color, aromatic odor, and deposit aspect. The chemical examination revealed an acidic pH of 5.5, negligible trace protein, absence of sugar, acetone, nitrite, and bilirubin, and normal urobilinogen levels. Leukocytes and blood were absent. The microscopic examination showed 4-6 pus cells/HPF (High Power Field), 2-4 RBCs/HPF, few epithelial cells/HPF, absence of casts, calcium oxalate crystals (++), and no ova, trophozoites, mucus, or fungi. These results indicate that the vital indicators are within the normal range.
Vital indicators after treatment
Based on the results of the medical tests conducted after receiving glucosodiene treatment on July 20, 2023, the patient's liver functions were within the normal range. The SGOT (Aspartate Aminotransferase) level was 32 U/L (up to 40 U/L), and the ASGPT (Alanine Aminotransferase) level was 26 U/L (up to 45 U/L). The ALP (Alkaline Phosphates) level was 164 U/L (normal: 40-100 U/L), and the AGGT (G-Gutamyl Transpeptidase) level was 23 U/L (normal: 7-40 U/L).
The kidney functions were also normal, with a serum creatinine level of 0.9 mg/dL (normal: 0.6-1.4 mg/dL) and a blood urea level of 24 mg/dL (normal: 15-45 mg/dL).
The cardiac markers showed a lactate dehydrogenase (LDH) level of 458 U/L (normal: 230-460 U/L).
In the hematological report, the blood picture showed a hemoglobin (Hgb) level of 12.2 g/dL (reference range: 11.7-15.5 g/dL), a red blood cells (RBCs) count of 4.52 x 10^6 cells/pl, and a hematocrit (Hct) level of 42.3% (reference range: 35-45%). Other parameters such as mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and white blood cells (WBCs) count were also within the normal range.
The urinalysis report indicated normal physical examination findings, including volume, color (amber-yellow), odor (aromatic), turbidity (absent), aspect (clear), and deposit (absent). The chemical examination showed an acidic pH of 6.5, negligible trace protein, and absence of sugar, acetone, nitrite, bilirubin, and urobilinogen. Leukocytes and blood were also absent. The microscopic examination revealed a few pus cells, no red blood cells (RBCs), epithelial cells, casts, crystals, ova, trophozoites, mucus, urine artifacts, fungi, or bacteria.
The coagulation profile showed a D-dimer level of 0.42 mg/L (normal: 0-0.50 mg/L), and the serum electrolytes indicated a phosphorous level of 4.58 mg/dL (normal: 2.5-5.0 mg/dL). The venous blood pH was 7.33 (normal: 7.4).
Based on these results, there were no signs of cellular toxicity or impairment in vital body functions after glucosodiene treatment. The liver, kidney, heart, pancreas, blood, blood pH, and urine were all within the normal range, indicating the safety of glucosodiene.