Hatem Soliman, MD: Preferred Treatment for HR+ MBC
Hatem Soliman, MD
Published Online:May 19, 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
HER2-Negative Metastatic Breast Cancer: Case 1
HER2-Negative Metastatic Breast Cancer: Case 2
Hatem Soliman, MD, Assistant Member, Women’s Oncology and Experimental Therapeutics, Moffitt Cancer Center, explains that many oncologists like to use Xeloda in ER+ disease that has progressed on prior endocrine therapies (especially if it is modest progression in organs or still bone only); otherwise, a taxane can be administered, if the patient is not refractory.
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
- 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)
