Metastatic Lobular Breast Cancer With Long-Term Disease Control Across Multiple Therapies

What happened, in summary

A 46-year-old woman underwent right quadrantectomy and sentinel-node biopsy in 2002 for grade 2 lobular breast carcinoma. The original tumor was ER negative, PgR negative and HER2 negative. She completed 6 cycles of epirubicin, 5-FU and cyclophosphamide and received breast radiation. A local recurrence in 2006 required right mastectomy, followed by 6 cycles of paclitaxel and hormone treatment with tamoxifen plus an LH-RH analogue. A skin recurrence was removed in 2010, and her hormone therapy was changed to letrozole. In 2012, the cancer spread to the pleura, liver and skin. Exemestane plus everolimus in a research protocol produced a partial response for 11 months. Fulvestrant followed, but disease later progressed in the pleura, liver, skin and bone. Nab-paclitaxel produced another partial response and was continued for 10 months. Eribulin was then started. After 6 cycles, the skin and liver metastases had completely responded, pleural disease had partially responded and bone disease was stable. After 12 cycles, progression returned in the pleura, skin and bone while the liver remained in complete remission. She received 45 Gy of chest-wall radiation, then capecitabine, and later metronomic vinorelbine. At the most recent follow-up she was alive, still receiving treatment and had substantial disease stabilization.