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

Joyce O'Shaughnessy, MD: Third-Line Options to Prolong Life

Joyce O'Shaughnessy, MD
Published Online:Apr 01, 2016
Connie C is a 56-year-old with no chronic conditions. In September of 2014, after presenting to her PCP with a palpable breast mass and fatigue of several months' duration she underwent a left mammogram revealing a large breast mass.

Triple Negative Breast Cancer with Andrew Seidman, MD and Joyce O'Shaughnessy, MD: Case 2



What are the third-line options available to prolong life in this patient?

In metastatic triple negative breast cancer, not all patients live long enough to receive third-line treatment. When patients do, we certainly want to chose a regimen that has been proven to prolong survival. After patients have received a taxane and anthracycline, and they need a third-line therapy, the only regimen we have that has been shown to improve survival is eribulin.

For that reason, eribulin is our number one choice. There are other treatments that have been shown to improve progression free survival, but eribulin is the only one in the third line or later setting that has been chosen to improve overall survival.

Triple Negative Breast Cancer: Case 2

Connie C is a 56-year-old television producer for a local news station, her medical history is unremarkable for any chronic conditions.

In September of 2014, after presenting to her PCP with a palpable breast mass and fatigue of several months’ duration she underwent a left mammogram revealing a large breast mass.

  • A CT scan of the chest/abdomen/pelvis showed a large primary mass in the left breast, multiple enlarged mediastinal lymph nodes, and several hepatic lesions consistent with metastases
  • Breast and liver biopsies showed poorly differentiated, mammary adenocarcinoma that was ER-, PgR- and HER2- (triple-negative) with Ki67 staining 70%
  • She began first-line chemotherapy with doxorubicin

In February of 2015, she returns with increasing fatigue and back pain; her CT scan shows progression of the hepatic lesions, and bone scan shows new lesions in the T4 and T5 vertebra. At the time of progression, her ECOG performance status (PS) is 1.

  • She began therapy with docetaxel plus capecitabine as part of a clinical trial and her disease stabilized after 5 cycles

In June of 2015, she returns for follow up with worsening back pain and intermittent dyspnea. Her CT scan at the time of progression shows the bone lesions worsening and several new bilateral pulmonary lesions.

  • Patient remains active, with good liver and renal function; her ECOG PS remains at 1
  • The oncologist initiates therapy with eribulin at a dose of 1.4 mg/m2; she tolerates the therapy well and shows a partial response after 5 cycles, with improvement of the bone and pulmonary lesions, and stable hepatic disease
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