A Remarkable Recovery Against All Odds

In October 2019, a 37-year-old woman of East Indian origin discovered a growing lump in her right breast during her second trimester of pregnancy. After delivering a healthy baby in February 2020, she sought medical attention. A physical examination revealed a large, non-tender breast mass with skin invasion and nipple inversion.

Further imaging and biopsy confirmed metaplastic breast carcinoma, an aggressive and rare form of breast cancer. While no distant metastases were initially detected, the tumor had deeply invaded the pectoralis muscle, leading to a clinical stage of cT4bN0M0.

A multidisciplinary team decided on upfront surgery. In June 2020, she underwent a right-modified radical mastectomy with axillary lymph node dissection. The tumor was larger than 10 cm and had invaded the skin and muscle. While most lymph nodes were negative, two of six showed micrometastatic disease. The final pathology confirmed pT4bN1M0.

Before chemotherapy could begin, she experienced rapid recurrence—a new bleeding tumor grew at the surgical site within four weeks. A biopsy confirmed locoregional recurrence, and subsequent scans revealed widespread lung metastases.

With the cancer advancing aggressively, doctors initiated atezolizumab (an immunotherapy drug) and nab-paclitaxel (a chemotherapy agent). Within two weeks, the chest wall tumor disappeared, and pain subsided completely. After three months, scans showed complete resolution of the lung metastases.

Due to the exceptional response, she remained on atezolizumab and nab-paclitaxel for one year, eventually transitioning to atezolizumab alone for maintenance therapy. After two years of treatment, scans showed no evidence of cancer, and in August 2022, she stopped therapy.

Her latest scan in October 2023 confirmed continued remission, and she enjoys an excellent quality of life with no long-term side effects.