Optimizing the Management of HER2+ Inflammatory Breast Cancer

60-year-old Woman WithHER2+ 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