Aman Chauhan, MD, discusses combining intratumoral Seneca Valley virus (SVV-001) with ipilimumab and nivolumab in neuroendocrine cancer.
|Videos|April 16, 2020
A 59-Year-Old Woman With HER2+ De Novo Metastatic Breast Cancer
A 59-Year-Old Woman With HER2+ De Novo Metastatic Breast Cancer
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Case: A 59-Year-Old Woman WithHER2+ De Novo Metastatic Breast Cancer
Initial presentation
- A 59-year-old, postmenopausal woman presented to her PCP for an annual physical exam, she was referred to undergo screening mammography; she reported back and hip pain along with occasional headaches
- PMHx: diabetes, medically controlled
- OB/GYNHx: nulliparous
- FHx: no family history of cancer
- PE: obese, palpable left breast mass with axillary adenopathy
Clinical workup
- Labs: alkaline phosphatase 230 IU/L (normal range 20-140 IU/L); otherwise WNL
- Breast imaging revealed a 2.1 cm irregular appearing mass in the left breast with suspicious axillary adenopathy
- Ultrasound-guided core biopsy of the left breast mass and axillary node confirmed high-grade infiltrative ductal carcinoma; ER-, PR-,HER2,3+ by IHC
- Brain MRI was negative
- PET/CT and bone scan revealed multiple lesions in the spine and pelvis; and several pulmonary nodules; pulmonary nodule biopsy revealed invasive ductal carcinoma; ER-,HER2+
- ECOG PS 1
Treatment and Follow-Up
- She was started on paclitaxel + trastuzumab + pertuzumab and completed 6 months of chemotherapy at which point paclitaxel was discontinued due to worsening neuropathy; trastuzumab and pertuzumab were continued
- Follow-up imaging at 3 months showed no FDG activity in the bones or lungs; bone pain resolved
- Denosumab was started to reduce skeletal related events
- Further follow-up imaging showed stable disease until 18 months when she developed worsening cough; imaging showed progressive bone disease and multiple new pulmonary nodules
- Trastuzumab emtansine (T-DM1) was started
- Follow-up imaging showed response to treatment which lasted for ~ 9 months
- She developed headaches, and increasing bone pain
- Brain MRI at that time showed 3 lesions, all < 2-cm; she was treated with SRS (stereotactic radio surgery)
- Bone scan showed progressive bone metastases
- Initiated neratinib 240 mg (6 tablets) PO QD + capecitabine
- She was started on prophylactic loperamide
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In a phase 1 trial, a single intratumoral injection of oncolytic virus SVV-001 with ipilimumab and nivolumab was safe in high-grade neuroendocrine cancers.
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