Objective: Case report of two patients who developed symptoms of Parkinson’s disease after treatment with chemotherapy and radiation for breast cancer and to review the current literature.

Background: Parkinson’s disease (PD) has been associated with a reduced risk of cancer compared to the general population with the exception of melanoma, which has been reported to occur more frequently in PD patients. (1–3) However, the relationship between breast cancer and PD has not clearly been defined. In one study, tamoxifen treatment in female patients with breast cancer was associated with an increased risk of developing PD. (4) There is limited data on the effect of chemotherapy on PD risk.

Methods: Chart review and literature search.

Results: Case 1: 61 yr old, with Grade 2 ER/PR+ invasive ductal carcinoma clinical stage IIB breast cancer, underwent chemotherapy with doxorubicin and cyclophosphamide for 4 cycles followed by 4 cycles of paclitaxel, bilateral total mastectomy and radiation. 1 yr following diagnosis developed left hand and leg resting tremor. Motor UPDRS Part 3 score was 21. MRI Brain was normal. DAT scan revealed evidence of bilateral presynaptic striatial dopaminergic deficits. Patient was started on Mirapex. UPDRS Part 3 score improved to 10 and there was tremor reduction. Case 2: 52 yr old, with poorly differentiated carcinoma with osteoblastic metastatic disease, compatible with breast origin, ER/PR+, HER-2 NEU positive. Initially treated with pertuzumab, Herceptin and Taxotere for 7 months with palliative radiation and bilateral mastectomy. Taxotere was discontinued and Zoladex and Letrozole were added. 1 year post chemotherapy she developed right hand resting tremor. Motor UPDRS Part 3 score was 6. MRI brain was normal. DAT scan revealed evidence of bilateral presynaptic striatial dopaminergic deficits. Patient was started on Mirapex. There was no significant improvement in UPDRS Part 3 score and tremor reduction was minimal.

Conclusions: There is growing evidence of the association between breast cancer and PD risk. However the exact mechanism of this relationship is unclear. Further studies are needed to evaluate the effect of chemotherapy on PD risk.

References: 1. A. Bajaj, J.A. Driver, E.S. Schernhammer, Parkinson’s disease and cancer risk: a systematic review and meta-analysis, Cancer Causes Control 21 (2010) 697-707. 2. C. Becker, G.P. Brobert, S. Johansson, S.S. Jick, C.R. Meier, Cancer risk in association with Parkinson disease: a population-based study, Park. Relat. Disord. 16 (2010) 186-190. 3. P. Tacik, S. Curry, S. Fujioka, et al. Cancer in Parkinson’s Disease. Park. Relat. Disord. 31 (2016) 28-33. 4. C. Hong, L. Chan, C. Hu, C. Lin, et al. Tamoxifen and the Risk of Parkinson’s disease in Female Patients with Breast Cancer in Asian People: A Nationwide Population Based Study. J Breast Cancer. 20 (2017) 356-360.

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