ONCAlert | 2017 San Antonio Breast Cancer Symposium
Breast Cancer Case Studies

Denise A Yardley MD: Controlling Metastatic Disease

Denise A. Yardley, MD
Published Online:Jun 18, 2015
Arlene C. is a 40-year-old premenopausal white woman from Cleveland who works as a pharmaceutical sales representative.

Triple-Negative Breast Cancer: Case 2


Dr. Yardley says that for Arlene, controlling her disease and improving survival is of paramount importance. She has been treated with a combination platinum-based regimen upfront, which was reasonable as it gave her disease an exposure of potentially 2 non– cross-resistant agents. The disease response status would be important to ascertain as some of her worsening symptoms can be ascribed to not only cumulative effects of chemotherapy, but may also overlap with disease progression. If her disease achieved a good response, one could consider dropping off one of the chemotherapy agents and just proceed with single agent mono-chemotherapy and move forward with the one agent imposing the least amount of laboratory and systemic toxicities. If her symptoms are due to disease progression, Dr. Yardley would switch her to another chemotherapy agent, likely a monotherapy with a non–cross-resistant agent, such as eribulin. If her disease is not progressing, a short break in therapy or flexibility in scheduling may be considered.

CASE 2: Triple-Negative Breast Cancer

Arlene C. is a 40-year-old premenopausal white woman from Cleveland who works as a pharmaceutical sales representative.

In November 2012, she was referred by her PCP for imaging and further evaluation after her initial mammography returned an abnormal result.
  • Mammography showed a 2.0-cm tumor
  • Core biopsy tested positive for IDC in left-lower outer quadrant (negative for ER and PgR; HER2 IHC 2+, but FISH-negative)
  • Patient’s family history was unremarkable for breast cancer; she declined genetic testing
  • Patient received breast-conserving surgery; sentinel lymph node evaluation was negative
  • Tumor classified as Stage 1A (T1bN0M0)
  • Patient received adjuvant TC chemotherapy (docetaxel 75 mg/m2 IV day 1, cyclophosphamide 600 mg/m2 IV day 1 cycled every 21 days for 4 cycles) with pegfilgrastim support, with subsequent adjuvant radiotherapy
In December 2013, patient returns to PCP complaining of intermittent cough and dyspnea; she is referred back to her oncologist for further workup.
  • PET scan showed evidence of local recurrence in the left breast and multiple lung nodules; bone scan showed a rib lesion
  • Having progressed within 12 months of her TC regimen, patient is considered partially taxane resistant
  • Biopsy of breast and lung nodule was consistent with the primary tumor’s phenotype
  • Gemcitabine/carboplatin chemotherapy was administered for metastatic disease (gemcitabine 1000 mg/m2 days 1 and 8, carboplatin AUC 2 IV, days 1 and 8, cycled every 21 days)
Following the 6th cycle, patient is unable to work with increasing fatigue, intermittent rib pain, and worsening dyspnea.
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