May 22, 2019


Case: A 52-Year-Old Woman withHER2+ Breast Cancer

H & P

  • A 52-year-old, postmenopausal woman presented with a mass in her left breast at her annual gynecologic exam; was referred to oncology
  • 2 children, menopause at age 49
  • No history of cardiovascular disease, no family history of breast cancer
  • PE: reveals a slightly overweight woman (BMI = 26 kg/m2), with palpable masses in left breast and left axillary nodes

Imaging

  • Mammogram reveals 2.5-cm tumor in left breast
  • CT: confirms tumor in left breast and left axillary node involvement (2.6-mm metastasis in 1 node)

Biopsy and labs:

  • Histology: invasive ductal adenocarcinoma
  • Histologic grade: G2
  • ER (-)/ PR (-)
  • HER2IHC, 3+
  • BRCA1/2status: unknown

Treatment

  • She received neoadjuvant TCH-P (docetaxel + carboplatin + trastuzumab + pertuzumab) and achieved pathologic complete response
    • Developed grade 3 diarrhea during second cycle of chemotherapy, which required a one-level dose reduction of paclitaxel
    • Diarrhea resolved to grade 1/2
  • Underwent breast-conserving surgery and removal of left axillary lymph nodes; no residual disease
  • Currently completing adjuvant therapy; trastuzumab + pertuzumab (total 18 cycles)