ONCAlert | 2018 ASCO Annual Meeting
Breast Cancer Case Studies

Mateusz Opyrchal, MD, PhD: Treating Rapidly Progressing MBC

Mateusz Opyrchal, MD, PhD
Published Online:May 20, 2015
Jeanne C, 61-year-old postmenopausal white woman from San Angelo, Texas, who works as a copyeditor.

HER2-Negative Metastatic Breast Cancer: Case 1



Mateusz Opyrchal, MD, PhD, Breast Service Co-Director, Experimental Therapeutics, RPCI Breast Disease Site Research Group, Department of Medicine, Roswell Park Cancer Institute, believes that the optimal chemotherapy utilized depends on the circumstances and individual patient characteristics. Most of the time, Opyrchal views failure within 6 months as a good indicator that cancer is resistant to that particular combination. Progression during neoadjuvant therapy is usually a bad prognostic sign and leads to either a change of therapy or a push for faster surgical intervention.

CASE 1: HER2-Negative mBC

Jeanne C, 61-year-old postmenopausal white woman from San Angelo, Texas, who works as a copyeditor.

2009: Presented to PCP after finding lump in right breast. Referred to oncologist for standard diagnostic workup.
  • Diagnosed with stage IIA (T1N1M0) infiltrating ductal adenocarcinoma; 2.0-cm lesion in upper outer quadrant of right breast
  • Fluorescence in situ hybridization determined HER2-negative/ER+/PR+ tumor
  • Patient was able to work but felt fatigued and was unable to lift heavy objects
  • Received lumpectomy and sentinel lymph node biopsy for initial surgery; malignant cells detected in 2 axillary lymph nodes
  • Patient began TC regimen (Oncotype DX 24): docetaxel 75 mg/m2 IV day 1 + cyclophosphamide 600 mg/m2 IV day 1; every 21 days for 4 cycles with filgrastim support
  • Chemotherapy was followed by nodal irradiation therapy and whole breast radiation (5x per week for 6 weeks). Started nonsteroidal aromatase inhibitor
  • Disease-free for almost 5 years after chemotherapy
After almost 5 years, patient reported bone pain and discomfort in upper right quadrant. Mammogram showed new lump in upper right breast.
  • Medical oncologist ordered bone scan and computed tomography (CT) scan
  • Patient able to work, but fatigued and working from home 2 days/week
  • Bone scan and CT scan revealed several potential lesions on spine and long bones
  • Biopsy and pathology showed metastases consistent with original breast cancer. Patient diagnosed with stage IV cancer
  • Biopsy confirmed HER2-negative/ER+/PR+ disease. Began denosumab for bone mets
  • Began treatment with fulvestrant 500 mg IM (2 x 5mL injections on days 1,15, and 29 and every 28 days thereafter)
Patient reports lower back pain before 3rd cycle. Results revealed visceral metastases on liver and on lung.
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