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Breast Cancer Case Studies

Case Studies: HER2+ BC: Residual Disease After Neoadjuvant Therapy

Sara M. Tolaney, MD, MPH, reviews the case of a 49-year-old woman with HER2-positive breast cancer treated with adjuvant T-DM1.

HER2+ BC: Residual Disease After Neoadjuvant Therapy

Case: A 49-Year-Old Woman With HER2+ Breast Cancer

H & P

  • A 49-year-old woman was referred by gynecology for a mass in her right breast
  • No children, menopause at age 45
  • No history of cardiovascular disease, otherwise good health
  • PE: revealed a woman of normal weight (BMI = 21 kg/m2), with a palpable mass in her right breast

Imaging

  • Mammogram revealed 3.5-cm tumor in right breast
  • CT: confirmed a tumor in right breast with no lymph node involvement

Biopsy and labs:

  • Histology: ductal, grade 2
  • ER(-), PR (-)
  • HER2 IHC: 3+
  • BRCA1/2: negative

Treatment

  • Diagnosed with ER/PR negative HER2+ breast cancer; she received neoadjuvant TCH-P (docetaxel + carboplatin + trastuzumab + pertuzumab and achieved a partial response
    • Residual disease of 1.5 cm after neoadjuvant therapy
  • Underwent mastectomy
  • After discussing with her the options for adjuvant therapy, benefits and risks of each, and her goals, she was started on ado-trastuzumab emtansine (T-DM1)
  • At present, she has completed 3 cycles of T-DM1
    • Reports numbness in her fingers, “like wearing gloves” that sometimes interferes with small tasks like buttoning a shirt

 

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