HER2-Positive Recurrent Breast Cancer Treated With Multiple Targeted and Local Therapies

What happened, in summary

A 54-year-old woman underwent right quadrantectomy for invasive ductal breast carcinoma in 1996, followed by anthracycline chemotherapy and hormone therapy. In 2008, a subclavicular lymph-node recurrence was found with ER 80%, PgR 25% and HER2 amplification. She received 3 cycles of CMF and had the lesion removed. Further nodal progression led to treatment with an LH-RH analogue, anastrozole, trastuzumab and 50 Gy of radiation. In 2011, recurrent lymph-node and skin disease was surgically removed. The new tissue remained hormone-receptor positive and was HER2 3+. Fulvestrant followed. Over the next several years she received multiple treatments for recurrent nodal and liver disease, including CyberKnife radiation, capecitabine plus lapatinib, trastuzumab plus vinorelbine, trastuzumab plus cyclophosphamide and trastuzumab emtansine. These produced periods of response, including complete liver response, followed by later progression. Eribulin was started in February 2016. After 3 cycles, PET-CT showed complete response in the liver and disappearance of right-axillary lesions, although one mammary lymph-node lesion persisted. She later received 24 Gy of stereotactic radiation to that area. By October 2017, nodal disease was stable and new upper-lung metabolic activity had appeared. She had received 25 cycles of eribulin and remained on treatment.