Stage 4 invasive ductal carcinoma: metastatic disease with bone involvement managed successfully

This breast cancer diagnosis at a glance

Stage at diagnosis
Stage IV
Subtype
Invasive Ductal Carcinoma
Biomarkers
ER <1%; PR 0%; HER2 score 3+; Ki-67 60%
Sex
Female
Spread to
bone (12th thoracic vertebra/T12)
Treatment
chemotherapy, targeted therapy, surgery and supportive care
Outcome
Responding Well

Treatment course, step by step

  1. Doxorubicin + cyclophosphamide (AC) and trastuzumab + docetaxel + pertuzumab [T12 bone metastasis became less clear, breast tumor did not improve]
  2. surgery postponed because of thyrotoxicosis from clinically diagnosed TSH-PitNET
  3. lanreotide normalized pituitary and thyroid function after 1 month
  4. trastuzumab deruxtecan (T-DXd) after breast tumor enlarged to 56 mm [reduced to 16 mm after 4 months]
  5. locoregional surgery/mastectomy 5 months after starting T-DXd [pathologic complete response in breast specimen]
  6. postoperative chemotherapy continued to prevent recurrence/metastasis; pituitary surgery deferred until chemotherapy completion.

What happened, in summary

A 52-year-old woman with a long history of thyroid disease noticed a right breast mass 2 years before the case report and sought breast evaluation 1 year later. Examination found a hard, poorly mobile 52 mm right breast mass. Mammography and ultrasound showed an irregular spiculated lesion, and needle biopsy confirmed invasive ductal carcinoma with fatty invasion. The tumor was ER

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

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