Stage IV triple-negative breast cancer in remission: CBD and exercise for neuropathy

What happened, in summary

A 52-year-old woman had a history of Stage IV triple-negative breast cancer with a solitary liver metastasis that disappeared after neoadjuvant treatment. By the time of this supportive-care case, her breast cancer had been in remission for more than 5 years. Her earlier cancer treatment began between 26 January and 19 April 2016 with 4 cycles of paclitaxel plus trastuzumab-pertuzumab. She then had bilateral mastectomy and left axillary lymph-node dissection. From 19 April 2016 to 14 July 2020, she received additional trastuzumab-pertuzumab for a total of 74 cycles and radiotherapy of 40.05 Gy in 15 fractions to the whole left breast, supraclavicular area, and internal mammary nodes. The case focused on survivorship symptoms rather than active cancer treatment. She presented with chemotherapy-induced peripheral neuropathy in her feet and neuropathic pain around the right axilla and shoulder. She first tried duloxetine 30 mg/day but stopped after 1 week because of intolerable hyperhidrosis. Later, she used cannabidiol (CBD), reaching 300 mg/day; the only reported CBD-related issue was mild, self-resolving diarrhea while increasing from 100 mg to 200 mg/day, and her liver enzymes stayed normal. In the final phase, she continued CBD 300 mg/day while completing an 8-week multimodal exercise program. No intervention-related adverse effects were reported in that phase. Across the CBD and exercise phases, she had clinically meaningful improvements in neuropathy symptoms, perceived physical function, overall quality of life, activity level, and several mobility and strength tests. Her comorbidities included liver steatosis, osteoarthrosis, and lymphedema, which made functional recovery and symptom control especially relevant survivorship outcomes.