Metastatic HER2-Positive Breast Cancer With Treatment-Related Telangiectasias

This breast cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Invasive Ductal Carcinoma
Biomarkers
HER2-positive; initially ER-negative and PR-negative; metastatic disease weakly ER-positive and PR-negative; germline testing negative
Sex
female
Spread to
left supraclavicular, mediastinal, axillary and subpectoral lymph nodes
Treatment
chemotherapy, targeted therapy, surgery, radiation and endocrine therapy
Outcome
Living With Cancer

Treatment course, step by step

  1. Received 6 cycles of neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab, followed by bilateral mastectomy with axillary dissection, additional trastuzumab, and radiation.
  2. After Stage IV recurrence in 2017, received docetaxel, trastuzumab, and pertuzumab, followed by letrozole and then brief fulvestrant.
  3. Began tucatinib with T-DM1 in March 2020.
  4. T-DM1 was later reduced and then stopped because of neuropathy, while tucatinib was resumed at a lower dose.

What happened, in summary

A 66-year-old woman was diagnosed in 2014 with Stage III HER2-positive invasive ductal carcinoma of the right breast. She received neoadjuvant docetaxel, carboplatin, trastuzumab, and pertuzumab, followed by bilateral mastectomy with axillary dissection, additional trastuzumab, and radiation.

In 2017, the cancer recurred as Stage IV disease involving multiple lymph-node regions. She received further HER2-directed therapy and endocrine treatment. In March 2020, she began tucatinib with T-DM1. After about 2 years, she developed numerous visible telangiectasias across her chest, neck, shoulders, and later her arms. The skin changes affected how she dressed and her emotional well-being.

Neuropathy also worsened, leading to treatment interruptions and eventual discontinuation of T-DM1 in early 2023. Tucatinib was restarted at a lower dose. The telangiectasias improved when treatment was held, recurred after tucatinib restarted, and later became less prominent after dose reduction and electrocautery. By 2023, she had been living with breast cancer for more than 9 years and remained on treatment for metastatic disease.

Where this story comes from

This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full

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