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Breast Cancer Case Studies

Case Studies: Optimizing the Management of HER2+ Inflammatory Breast Cancer

Debu Tripathy, MD, reviews the case of a 60-year-old woman who presents with HER2+ inflammatory breast cancer.

Optimizing the Management of HER2+ Inflammatory Breast Cancer

60-year-old Woman With HER2+ Inflammatory Breast Cancer

  • A 60-year-old woman presented to her gynecologist with redness, tenderness, and swelling of her right breast over the last 2 weeks
    • PMH: HTN managed with HCTZ/triamterene
    • FH: unremarkable
    • PE: palpable mass in the right inferior breast with skin thickening; no palpable lymphadenopathy
    • ROS: clear, no fever
  • Breast ultrasound revealed a solid right-sided 3.8-cm mass at the 10:00 position with no posterior acoustic shadowing; abnormal enlargement of 2 right axillary lymph nodes
  • Core needle biopsy of the breast mass revealed high grade infiltrating ductal carcinoma; HER2+
  • Fine needle biopsy of a right axillary node confirmed carcinoma 
  • Punch biopsy of the skin showed dermal lymphatic invasion with carcinoma cells
  • PET/CT staging showed increased uptake over right breast, diffusely, and with at least 2 nodes seen in the right axillary basin; no evidence of distant metastases
  • Clinical staging: T4dN1M0
  • She received neoadjuvant therapy consisting of dose-dense AC X 4-THP X 4; physical exam was consistent with a complete clinical response
  • She then underwent right modified radical mastectomy; pathology showed a complete pathologic response
  • Following surgery, she was treated with adjuvant trastuzumab + pertuzumab to complete one year of monoclonal antibody therapy
  • The patient completed radiation therapy to the right chest wall and regional nodes
  • She was placed on letrozole
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