What happened, in summary

A 73-year-old man was diagnosed in 2007 with locally advanced invasive ductal cancer of the right breast after living with a breast lump for several years. Staging found no distant spread, and he underwent radical mastectomy with axillary lymph-node dissection. The tumor was estrogen-receptor positive, progesterone-receptor positive and HER2-positive. He then received 6 cycles of docetaxel plus epirubicin, tamoxifen, radiotherapy and 1 year of trastuzumab.

After a disease-free interval of 5 years and 6 months, bone metastases appeared in 2013. Over the following years he received several lines of endocrine, HER2-directed and bone-targeted treatment. Later testing showed that the metastatic cancer was ER-positive but PR-negative and HER2-negative. Everolimus plus exemestane controlled the disease for 28 months, and palbociclib plus fulvestrant produced another response lasting about 25 months.

By 2020, the cancer had progressed in bone and newly involved the liver. A PIK3CA mutation was identified, but he did not start the proposed alpelisib regimen and declined further chemotherapy. He transitioned to best supportive care and died in January 2021, more than 13 years after his original breast-cancer diagnosis.