Metastatic Breast Cancer With Bone and Liver Progression After Multiple Therapies

What happened, in summary

A 37-year-old woman underwent lumpectomy and axillary dissection in 2006 for grade 2 invasive ductal breast carcinoma. The tumor was ER 80%, PgR 60% and HER2 negative. She received epirubicin/cyclophosphamide followed by paclitaxel, radiation and tamoxifen. In 2009, vertebral metastases were detected. Hormone treatment with aromatase inhibitors and an LH-RH analogue produced a partial response, but bone disease progressed in 2011. She then received 8 cycles of capecitabine. Fulvestrant plus an LH-RH analogue later produced a complete response before another bone progression. Oral vinorelbine, short-course radiation and bone-directed therapy produced another temporary response. By October 2013, the cancer had reached the liver. A liver biopsy remained hormone-receptor positive and HER2 FISH negative. Docetaxel produced a partial response after 4 cycles, followed by progression after 9 cycles. Eribulin was started in July 2014 and continued for 10 cycles, with improved quality of life and no major toxicity, before the liver disease progressed again. Weekly liposomal epirubicin produced another partial response. By December 2015, however, she developed ascites and jaundice, and CT showed massive hepatic involvement with liver failure. Chemotherapy was stopped, and she died on January 31, 2016.