HER2-positive breast cancer: AC-THP treatment completed after infusion-port salvage

What happened, in summary

A 55-year-old woman with HER2-positive breast cancer had a totally implantable venous access port placed through the internal jugular vein in March 2022. Chest x-ray confirmed the catheter tip position, and she began the AC-THP regimen the next day. She completed 6 cycles successfully. In August 2022, she noticed thinning and itching over the port pocket, together with marked anxiety about the site. She told her team she had been doing frequent chest-expansion exercises and wearing tight undergarments, both of which could put pressure on the area. Her care team advised stopping those activities and used topical epidermal growth factor, sterile gauze coverage, and emotional support. During the seventh cycle, the skin thinning progressed, although the port was not yet exposed. The team considered infection, rupture, and drug leakage, but none was found. By September, the port became exposed and painful. She strongly preferred not to remove the port or switch to peripheral venous access because more treatment was still needed. Since the exposed area was small, with no infection or extravasation, a catheter specialist created a new pocket next to the old one. The port body was intact, the existing non-coring needle was retained, the puncture hub was moved into the new pocket, and the pocket opening and old incision were reinforced. Healing was satisfactory after 24 hours, and x-ray showed an improved catheter-tip position. She completed all planned treatments without recurrent skin thinning or exposure over the following 2 years, and the port was removed in October 2024.