Stage 4 breast cancer: 4 years and counting

What happened, in summary

This 61-year-old woman was first diagnosed in September 2018 with left breast invasive ductal carcinoma that was hormone receptor positive and HER2 1+. She received neoadjuvant chemotherapy with doxorubicin, cyclophosphamide, and docetaxel, then underwent partial mastectomy with sentinel lymph-node biopsy in March 2019. Pathology showed pT2N1a disease. Adjuvant endocrine therapy was recommended, but she declined. She remained well until March 2022, when a cough led to CT imaging that showed a left lower-lobe mass with mediastinal and hilar lymphadenopathy. Bronchoscopy in July 2022 confirmed metastatic triple-negative breast cancer, showing receptor conversion from the original hormone receptor-positive tumor. Staging scans also found liver, bone, right supraclavicular, and thoracic nodal metastases. Because she was short of breath, she received palliative radiation to the left lung and left hilum in August 2022. Soon after, she noticed visual floaters, and eye evaluation found bilateral choroidal masses. She received radiation to both eyes between September and October 2022, with 4500 cGy to the left eye and 3420 cGy to the right eye, complicated by severe dry eyes from radiation keratopathy that required artificial tears. Sacituzumab govitecan began in October 2022, and an eye exam after the first 2 doses showed dramatic shrinkage of both ocular tumors. She completed 6 cycles, with intermittent diarrhea and fatigue, until progression in February 2023. Brain MRI showed multiple cerebellar lesions and a pituitary lesion. She started doxorubicin in April 2023, but disease continued to progress. After obstructive hydrocephalus developed, she chose hospice in May 2023 and died in June 2023.