CASE SELECTION 4: Long-Term Survival with Stage 4 HER2-Positive Breast Cancer
“Case Selection” is a new format designed to highlight inspiring patient cases focused on challenging situations such as multiple recurrences, extensive metastases, rare subtypes, no longer response to standard treatments. Each case is derived exclusively from peer-reviewed medical journal case reports, rewritten by Patient Savvy in clear, easy-to-understand language without altering any critical information.
This collection highlights real stories of breast cancer patients who achieved long-term survival through multiple lines of treatment—options often not fully detailed in standard guidelines (You can download FREE HERE). Their experiences show the power of self-advocacy and the importance of speaking with your doctor about personalized treatment paths.
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10+ years with HER2-positive metastatic breast cancer
HER2-positive metastatic breast cancer with lung involvement
Complete pathological response with over a decade of disease-free survival
In 2010, a 42-year-old woman sought medical attention after experiencing worsening swelling, tenderness, and redness in her left breast over several days. Upon examination, doctors noted an enlarged breast with peau d’orange skin changes, nipple retraction, and swollen axillary lymph nodes. A core needle biopsy confirmed invasive ductal carcinoma, which tested negative for hormone receptors but strongly positive for HER2 (FISH ratio 8.3). Further scans revealed numerous small lung nodules, later confirmed to be metastatic HER2-positive breast cancer.
The patient immediately began treatment with paclitaxel and trastuzumab, a targeted therapy designed for HER2-positive cancers. She later transitioned to a combination of docetaxel, carboplatin, and trastuzumab, completing six cycles (18 weeks) of treatment. Follow-up imaging revealed a complete response in the lungs, though some skin thickening remained in the affected breast.
Given the concern for residual disease, doctors proceeded with local radiation therapy, delivering 5,000 cGy to the breast and 4,600 cGy to the regional lymph nodes. Meanwhile, trastuzumab monotherapy was continued as maintenance treatment. After two months, her breast showed a significant response, allowing her to undergo a left modified radical mastectomy. Pathology reports revealed a complete pathological response—no remaining invasive cancer in the breast or lymph nodes.
Now, more than 10 years and 10 months since her initial diagnosis, the patient remains on trastuzumab therapy with no evidence of disease recurrence. Her case highlights the effectiveness of targeted HER2 treatments, radiation, and surgery in achieving long-term remission for advanced breast cancer.
Source: Ge, J. Y., & Overmoyer, B. (2021). Prolonged survival in patients with metastatic HER2-positive inflammatory breast cancer: a case report and review of the literature. Case Reports in Oncology, 14(2), 1071-1079.
7+ years with HER2-postive breast cancer diagnosed at 34
Stage 3 HER2-positive breast cancer, diagnosed at age 34, later progressing to metastatic disease
Successfully delivered a healthy baby while remaining cancer-free, with ongoing monitoring and treatment considerations
In September 2015, a 34-year-old premenopausal woman was diagnosed with stage III invasive ductal carcinoma of the right breast. Her cancer was classified as estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-positive. She sought treatment at MD Anderson Cancer Center in Houston, Texas, and began an aggressive battle against the disease.
Her journey began with a right mastectomy and axillary lymph node dissection, followed by chemotherapy and targeted therapy with Trastuzumab. Unfortunately, she developed symptomatic cardiomyopathy, leading to the temporary discontinuation of Trastuzumab in June 2016. After several months of cardiac monitoring, her heart function improved, allowing her to resume treatment.
In October 2017, follow-up scans revealed lung and mediastinal lymph node metastases, marking a recurrence of her disease. She switched to second-line therapy with ado-Trastuzumab Emtansine (TDM-1), which showed promising results. However, due to severe fatigue and liver toxicity, she transitioned to dual-antibody therapy with Trastuzumab-Pertuzumab in February 2018. Though she faced periodic interruptions due to cardiac concerns, her scans continued to show no evidence of disease.
In January 2020, her treatment was paused due to another drop in heart function, but she resumed Trastuzumab-Pertuzumab after recovery. Throughout 2021 and 2022, she remained on treatment, though with occasional delays due to personal reasons.
In December 2022, the patient discovered she was pregnant, just 12 days after her last Trastuzumab-Pertuzumab cycle. Despite medical advice warning of potential complications, she chose to continue the pregnancy. Close monitoring at the Maternal Fetal Medicine Clinic showed positive fetal development, with no congenital abnormalities detected.
At 38 weeks, she had a spontaneous vaginal delivery of a healthy baby boy. Postpartum evaluations, including PET-CT and echocardiography, showed no evidence of cancer recurrence, and her cardiac function remained stable.
Three weeks after childbirth, she returned for an oncology consultation and was offered options to resume treatment. She chose to wait three months to focus on breastfeeding before making a decision.
Source: Al-Shamsi, H. O., Abdelwahed, N., Singh, M., Abyad, A. M., Elsabae, S., Abdelgawad, T., … & Abdeljawad, T. (2023). First Reported Case of Successful Conception and Delivery During Stage IV Breast Cancer Treatment: A Case Report and Literature Review. Cureus, 15(10).
From liver metastasis to no detectable cancer
HER2-positive metastatic breast cancer confirmed by breast and liver biopsies
Complete pathological response with no detectable cancer, ongoing maintenance therapy, and continued remission
In May 2021, a 51-year-old postmenopausal Chinese woman visited Yongchuan Hospital of Chongqing Medical University after noticing a painless, irregular mass in her left breast. She had no prior medical history or co-morbidities. Imaging tests, including ultrasound and mammography, revealed two connected masses in the lower inner quadrant of the breast, alongside a low-density liver lesion detected on an abdominal CT scan. While no lymph node abnormalities were observed, biopsies of both the breast and liver confirmed invasive carcinoma with liver metastasis. The cancer was classified as HER2-positive, meaning it could potentially respond well to targeted therapies.
Given the HER2-positive status, a treatment plan incorporating dual-targeted therapy and chemotherapy was initiated. The patient received six cycles of nab-paclitaxel combined with trastuzumab and pertuzumab, followed by an additional 11 cycles of dual-target therapy alone. She tolerated the regimen well, with no significant adverse effects.
After six cycles of treatment, follow-up imaging showed a significant reduction in the liver metastasis, shrinking from 4.6 cm × 3.0 cm to just 0.8 cm × 0.5 cm. The primary breast tumor had completely disappeared on imaging. Encouraged by this progress, the patient opted for surgery.
A thorough preoperative evaluation, including MRI and CT scans, confirmed the complete disappearance of liver metastases and no new evidence of disease progression. In response to these findings and retrospective studies suggesting improved survival with tumor resection, a simple mastectomy of the left breast was performed. The postoperative pathology report revealed a complete pathological response—an extraordinary outcome.
Since surgery, the patient has been on trastuzumab maintenance therapy every three weeks. She continues to do well, with no evidence of disease recurrence during routine follow-ups. Given the uncertainty around the optimal duration of maintenance therapy, ongoing observation remains crucial to balance effectiveness with potential side effects and treatment burden.
Source: Zhang, T., Liu, Y., Yang, L., & Tian, T. (2024). Complete response after treatment of breast cancer with isolated liver metastasis: a case report. AME Case Reports, 8, 28.
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