ONCAlert | 2018 ASCO Annual Meeting
Breast Cancer Case Studies

William J. Gradishar, MD: Triple-Negative Phenotype's Influence on Treatment

William J. Gradishar, 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. Gradishar says believes that the presence of triple-negative phenotype does not influence treatment of the patient. In 2014, the choice of adjuvant chemotherapy for TNBC is the same as any other kind of breast cancer which may receive chemotherapy.

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.
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.