Stage 4 breast cancer: ongoing treatment with multi-line chemotherapy

What happened, in summary

A 40-year-old Syrian premenopausal woman had right breast invasive ductal carcinoma treated before September 2005 with right partial mastectomy and axillary dissection. Pathology showed grade 1 invasive ductal carcinoma that was hormone receptor-negative and HER2 2+ equivocal. She then received 6 cycles of FAC chemotherapy, followed by radiation. In August 2009, she developed local and nodal recurrence in the right breast and axilla. Treatment included 1 cycle of FAC and 2 cycles of 5-fluorouracil plus cyclophosphamide, followed by modified radical mastectomy with axillary dissection in November 2009. Pathology showed grade 2 invasive ductal carcinoma with 2 of 14 lymph nodes positive, ypT1N1M0, again hormone receptor-negative and HER2 2+ equivocal. She then received 6 cycles of paclitaxel plus carboplatin. In November 2011, a right supraclavicular nodule proved to be recurrent invasive ductal carcinoma, now ER 10%, PR 70%, and HER2 2+ equivocal. She received 6 cycles of paclitaxel and then tamoxifen. In October 2012, bilateral pleural effusion, right lung nodules, breathlessness, and positive pleural cytology established metastatic breast cancer with malignant pleural effusion. Carboplatin plus intravenous vinorelbine was changed to capecitabine plus oral vinorelbine after chemotherapy-induced cardiomyopathy. From January 2014, aromatase-inhibitor therapy with periodic zoledronic acid led to complete response. Osteoporosis in 2021 led to a switch to tamoxifen. PET-CT in October 2023 still showed complete response, and the team planned review of whether to stop endocrine therapy after 10 years. Follow-up included clinical examinations every 3 months, imaging and laboratory monitoring every 6 months, and additional CT or bone scans when needed, which supports the long-term complete-response outcome.