ONCAlert | 2018 ASCO Annual Meeting
Breast Cancer Case Studies

Mateusz Opyrchal, MD, PhD: Treating Liver-Metastatic MBC

Mateusz Opyrchal, MD, PhD
Published Online:May 20, 2015
Kim W, 53-year-old postmenopausal woman of Asian decent from Morristown, New Jersey, who worked as an accountant.

HER2-Negative Metastatic Breast Cancer: Case 2

Mateusz Opyrchal, MD, PhD, Breast Service Co-Director, Experimental Therapeutics, RPCI Breast Disease Site Research Group, Department of Medicine, Roswell Park Cancer Institute, suggests that the patient seems to have a de novo resistance to endocrine therapy with an AI. In ER/PR+ tumors in a metastatic setting, endocrine therapy is the preferred treatment option, as it has a better side-effect profile. In this case, her back pain takes precedence over systemic therapy, and it needs to be investigated to rule out cord compression.

CASE 2: HER2-Negative Chemotherapy-Resistant mBC

Kim W, 53-year-old postmenopausal woman of Asian decent from Morristown, New Jersey, who worked as an accountant.

2013: Presented to PCP after finding a lump in right breast. Referred to oncologist for standard diagnostic workup.
  • Diagnosed with infiltrating ductal adenocarcinoma; 5.5-cm lesion in lower outer quadrant of right breast and palpable ipsilateral axillary nodes, which were FNA+ for adenocarcinoma
  • Fluorescence in situ hybridization determined HER2-negative/ER+/PR+ tumor
  • Patient was able to work and carry out daily activities (KPS score 94)
  • Bone scan and chest diagnostic CT revealed no metastases
  • Neoadjuvant therapy begun with dose-dense AC: doxorubicin 60 mg/m2 IV q2 weeks followed by weekly paclitaxel 80 mg/m2 x 12
  • Patient underwent breast-conserving therapy (malignant cells in 7 axillary lymph nodes)
  • Surgery followed by chest wall and regional lymph node radiation therapy (5x/week for 6 weeks). Started nonsteroidal aromatase inhibitor.
5 months after adjuvant chemotherapy treatment, patient complained of bone pain.
  • Patient was unable to work, but could carry out self care and some home upkeep
  • Bone scan and CT scan revealed several metastases: 2 lesions on right leg bone measuring 2-3 cm, 2 lesions on liver measuring 2-3 cm; 1 lesion on lung measuring 2-3 cm
  • Patient identified as potentially resistant to taxane (having progressed within 12 months of last adjuvant therapy)
  • Liver biopsy and pathology showed metastases consistent with original breast cancer. Patient diagnosed with stage IV cancer
  • Histology confirmed HER2-negative/ER+/PR+ disease. Began therapy with denosumab for bone metastases
  • Also received Xeloda 1000 mg/m2 PO BID day 1-14
Also received Xeloda 1000 mg/m2 PO BID day 1-14
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