ESMO Preceptorship Programme

Cristina David

Medical Oncology Resident

Coltea Clinical Hospital

Bucharest

Case presentation

Metastatic Breast Cancer

ESMO Perceptorship on Breast Cancer 2017, Lisbon, Portugal 10-11 nov.2017

ESMO PRECEPTORSHIP PROGRAM

Patient΄s History

NF, female, 58 years old

Family history-no family history of breast or

ovarian cancer

Past medical history-no relevant past medical

or surgical history

Gynecologic-obstetric history-non relevant

ESMO PRECEPTORSHIP PROGRAM

Patient΄s History

09/2014-breast lump in the upper outer quadrant

Mammography-30 mm infiltrative nodule in the upper outer quadrant, BIRADS 3.5

Core Biopsy-invasive carcinoma,Grade 3, ER 80%, PR 20%, HER2/neu-negative, Ki67-60%.

CA15-3- 49.9 u/ml, CEA- normal value

Bone scan-negative

ESMO PRECEPTORSHIP PROGRAM

First line treatment -1

Chemotherapy- Neoadjuvant setting

September 2014-Fluorouracil 500 mg/sqm

+Doxorubicin 50 mg/sqm +

Cyclophosphamide 500 mg/sqm q3 wks- 8

courses

January 2015- CA15-3-80.1 u/ml

February 2015-two breast nodules in the upper

outer quadrant 4-5 mm. No axillary limph

node involvment.

ESMO PRECEPTORSHIP PROGRAM

March 2015- Left breast radical mastectomy

HP-invasive carcinoma,Grade 2, ER 80%, PR 70%, HER2/neu-

negative, Ki67-10%, R0, 15 lymph nodes invaded from 17 lymph

nodes examined. ypT2 ypN3a Mx stage IIIC Luminal B-like

Source-https://www.cancer.gov/types/breast/surgery-choices

ESMO PRECEPTORSHIP PROGRAM

Bone scan after surgery- suspicious bone

lesion on the 6th left posterior costal arch

April 2015► Letrozole started CA15-3-56.3

u/ml

Letrozole continued up to February 2016

Second line treatment- 2

Endocrine therapy –Adjuvant setting

ESMO PRECEPTORSHIP PROGRAM

Adjuvant Radiation Therapy June-July 2015- External beam radiotherapy

on thoracic wall, 50 Gy, left axilla 50 Gy

Source-http://www.breastscancersymptoms.com/breast-cancer-treatment/radiotherap

y-for-breast-cancer/

ESMO PRECEPTORSHIP PROGRAM

Second line treatment- 3

Endocrine therapy-Metastatic setting

Febr 2016-Bone scan-bone lesion on the 6th

left posterior costal arch, new lesions at the left

iliac bone, left femural neck.CA15-3- 142

u/ml

PET/CT- metabollicaly active bone lesions

vertebral body L5, S1,S2, right acetabulum

Febr 2016-July 2016 – Exemestane +

Biphosphonates

ESMO PRECEPTORSHIP PROGRAM

Third line treatment-3

Endocrine therapy-Metastatic setting

July 2016-CA15-3-449 u/ml, bone scan- new

lesions right scapula, left ischium, sacroiliac

joints►progression M1OSS

July-October 2016—Fulvestrant +

biphophonates

ESMO PRECEPTORSHIP PROGRAM

Palliative Radiation Therapy

Lumbar spine and pelvic bone pain-August 2016-

Palliative radiation therapy , TD-20 Gy

By Mikael Häggström -Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=54552293

ESMO PRECEPTORSHIP PROGRAM

Fourth line treatment-4

Chemotherapy- Metastatic setting

October 2016- CA15-3-1400 u/ml, CT and

bone scan reveal progression of bone

metastases (3rd costovertebral joint, greater

trochanter)

Change to palliative chemotherapy with

Docetaxel 80 mg/sqm (October 2016-April

2017)+ Biphosphonates

ESMO PRECEPTORSHIP PROGRAM

Fifth line chemotherapy-5

Chemotherapy-Metastatic setting

april 2017-neurological evaluation-Grade 3

peripheral neuropathy

CA15-3-1010 u/ml, CT –stable disease

Change chemotherapy with Capecitabine

1000 mg/sqm + biphosphonates (april 2017-

august 2017)

ESMO PRECEPTORSHIP PROGRAM

Sixth line chemotherapy-6

Chemotherapy –Metastatic setting

August 2017- Thoracic-abdomen-pelvis CT-

progression M1OSS, MIPUL, M1LYM,

CA15-3-1470 u/ml

Cardiac evaluation –LVEF- 60%, normal ECG

Change chemotherapy with Liposomal

doxorubicin 40 mg/sqm + Biphosphonates

(August 2017-in course)

ESMO PRECEPTORSHIP PROGRAM