Treatment-Refractory Triple-Negative Breast Cancer Treated With Tumor-Infiltrating Lymphocytes

What happened, in summary

A 31-year-old woman was diagnosed with locally advanced cancer in her right breast in 2020. Imaging showed two breast tumors and marked axillary lymph-node involvement without distant disease. The initial biopsy showed mixed invasive ductal and lobular carcinoma, and germline testing identified a pathogenic BRCA1 variant.

She received doxorubicin plus cyclophosphamide, then paclitaxel with carboplatin, followed by bilateral mastectomy. The surgical specimen showed residual disease with 7 of 8 lymph nodes involved and a triple-negative phenotype. She completed radiation to the chest wall and axilla, but soon developed skin and lung metastases. Over the following course she received capecitabine, olaparib, pembrolizumab with palliative skin radiation, sacituzumab govitecan, and other systemic therapy as the cancer continued to progress into the lungs and bones.

With few options remaining, she underwent experimental tumor-infiltrating lymphocyte therapy after lymphodepleting chemotherapy. IL-2 had to be stopped after severe toxicity including shock, kidney failure, myocarditis, and heart failure. Her tumor burden briefly decreased and she was discharged, but the cancer rapidly relapsed. She died about 1 month after the TIL and IL-2 treatment began.