May 23, 2019


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 (-)
  • HER2IHC: 3+
  • BRCA1/2: negative

Treatment

  • Diagnosed with ER/PR negativeHER2+ 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