Recurrent Breast Cancer With Liver Metastases Treated Through Multiple Chemotherapy Lines

What happened, in summary

A 60-year-old woman underwent right quadrantectomy and axillary dissection in 1996 for grade 2 invasive ductal breast carcinoma. The tumor was ER and PgR positive and HER2 0. Many years later, in 2012, mediastinal lymph-node disease was confirmed as recurrent breast cancer. Letrozole produced a partial response, but the nodes later enlarged and she changed to fulvestrant. Further progression led to sequential chemotherapy with metronomic capecitabine and then oral vinorelbine. By early 2016, multiple liver metastases were present. Liposomal doxorubicin was tried for 6 cycles, followed by weekly nab-paclitaxel. A liver biopsy confirmed metastatic breast cancer with ER 100%, PgR 0% and HER2 not amplified. Despite nab-paclitaxel, liver disease progressed. In November 2016, she started eribulin at a reduced dose because of her age and previous treatment. Over 18 cycles and about 10 months, liver metastases and nodal disease partially decreased, and the treatment was generally well tolerated apart from hair loss. In September 2017, tumor markers rose again and imaging showed renewed liver progression. Eribulin was discontinued, and she started weekly carboplatin as the next line of active treatment.