What happened, in summary

A 45-year-old woman found a roughly 1 cm lump in her right breast in 1996. Surgery showed grade 3 invasive ductal carcinoma with ER 90%, PgR 90%, HER2 3+ and Ki67 15%. She then received an LH-RH analogue and tamoxifen for about 5 years. In 2004, worsening shortness of breath and cough led to detection of pleural recurrence. Six cycles of epirubicin and docetaxel produced a complete response, followed by long-term letrozole. She stopped letrozole in 2011. In 2014, new right-upper-abdominal pain led to discovery of multiple liver metastases. Biopsy showed a changed profile: ER 30%, PgR 25%, HER2 negative and Ki67 35%. Four nab-paclitaxel infusions produced no response. Capecitabine plus vinorelbine was tried next, but capecitabine was stopped after 2 cycles because of grade 3 hand-foot syndrome and the liver cancer progressed. She then started eribulin. After 8 cycles, the largest right-liver lesion had fallen from 39 mm to about 1 cm, and her pain score improved from 7 to 0. She completed 18 courses before new liver lesions appeared in February 2016. After further treatment with letrozole plus palbociclib and additional liver progression, she moved to pegylated liposomal doxorubicin and remained in active care.