ONCAlert | Upfront Therapy for mRCC
Breast Cancer Case Studies

Hatem Soliman, MD: Treating Recurrent MBC

Hatem Soliman, MD
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

Hatem Soliman, MD, Assistant Member, Women’s Oncology and Experimental Therapeutics, Moffitt Cancer Center, recommends that the patient in the case study could receive Afinitor/Aromasin, weekly paclitaxel, or Xeloda. All these agents are reasonable therapies, as BOLERO-2 had patients with visceral disease. Paclitaxel can still be effective in someone who is 5 years out from an adjuvant taxane, Soliman suggests, and Xeloda would be a convenient treatment option with no alopecia.

Abraxane would also be a reasonable choice. Soliman feels that Abraxane is a good treatment option in this case stuy and recommends that mutation testing should be considered.

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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