What are the principle third-line options for patients like Christine with metastatic TNBC?
For this patient, who received both anthracycline, as well as a taxane in the adjuvant setting, and also for metastatic disease, we are confronted with a number of agents that she hasn't seen before. Until recently, it was very much the wild west, where you could recommend many different options and it was a lot of art and not a lot of science. Now we have an evidence-based approach based on the randomized, phase III trial known as EMBRACE.
In that trial, eribulin mesylate (Halaven) was shown to be superior to treatment of physicians' choice. Doctors were able to pick and choose amongst a number of commonly-used drugs, and the most commonly chosen agents were vinorelbine, capecitabine, gemcitabine, and amongst those agents were other regimens as well, but Halaven offered a survival advantage, so I think it's very hard now to argue with a prospective randomized trial showing that there's a clean winner in the third-line treatment and beyond.
Triple Negative Breast Cancer: Case 1
Christine H is a 54-year-old stay-at-home-mother who works part time as a real estate agent. Medical history is notable for hypertension (well controlled) and surgery for aortic aneurysm in 2011
In September 2013, she presented to her PCP with a right breast lump; mammogram showed a large primary breast mass and two enlarged axillary lymph nodes.
At her follow-up in May 2014, the patient showed progression of the right chest wall metastases, and several new liver lesions were detected.
In December of 2014, she presented with increasing fatigue and chest pain on follow up and her CT scan was consistent with progression of the hepatic metastases, with several new lesions also noted in the lungs; her ECOG performance status (PS) at the time was 1.