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Breast Cancer Case Studies

Case Studies: Metastatic Triple-Negative Breast Cancer

Reshma L. Mahtani, DO, discusses the treatment of a 55-year-old African American woman who presents with triple-negative breast cancer.

Metastatic Triple-Negative Breast Cancer

A 55-year-old Woman With Advanced TNBC

June 2015

  • Patient History
    • A postmenopausal 55-year-old African American woman who was first diagnosed with breast cancer 2 years ago after discovering a lump in her right breast
    • SH: active with 2 teenaged children
    • Imaging revealed the likelihood of a multifocal lesion (2.5 cm.) in the right breast and right axillary lymph node involvement
  • Pathology findings from ultrasound-guided core needle biopsy:
    • Histologic grade 3 invasive ductal carcinoma
    • Hormone receptor status: ER(-), PR(-)
    • HER2(-) IHC, 0
  • BRCA1/2 testing, negative
  • She underwent mastectomy followed by immediate reconstruction; 2 of 20 nodes positive
    • Surgical staging T2pN1M0
  • Following surgery, she received adjuvant doxorubicin/cyclophosphamide followed by paclitaxel (12 weeks); pt. had difficulty completing CT due to significant diarrhea and CINV

October 2017

  • Routine follow up at 18 months:
    • Patient reported having worsening cough and abdominal pain
    • Imaging revealed 3 lesions in her right lung (<2 cm) and several liver lesions
    • Biopsy confirmed metastatic TNBC
  • She was started on treatment with gemcitabine/carboplatin; she required dose reduction for neutropenia; imaging at 3 months showed stable disease

May 2018

  • Seven months after starting gemcitabine/carboplatin, imaging showed progression in a single right lung nodule (now 3.2 cm)
  • After discussion of her therapy choices, the patient opted for treatment with capecitabine

August 2018

  • Imaging at 3 months showed 4 new liver lesions
  • She started treatment with eribulin 1.4 mg/m2 IV on days 1 and 8 of each 21-day cycle
    • Two weeks after her first dose, she developed grade 3 neutropenia without fever
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