Andrew Seidman, MD: Third-Line Options to Prolong Life

What are the third-line options available to prolong life in this patient?

In the setting of third-line chemotherapy for metastatic disease, we think about what patients have had before. For patients like Connie, who has had an anthracycline and has had a taxane together with capecitabine, so she received docetaxel and capecitabine, the usual suspects have historically been agents such as vinorelbine, gemacitabine, perhaps ixabepilone, and now more recently Halavan, or eribulin, which ultimately is the most evidence-based choice based on the randomized phase III data from the EMBRACE trial.

Triple Negative Breast Cancer: Case 2

Connie C is a 56-year-old television producer for a local news station, her medical history is unremarkable for any chronic conditions.

In September of 2014, after presenting to her PCP with a palpable breast mass and fatigue of several months’ duration she underwent a left mammogram revealing a large breast mass.

• A CT scan of the chest/abdomen/pelvis showed a large primary mass in the left breast, multiple enlarged mediastinal lymph nodes, and several hepatic lesions consistent with metastases
• Breast and liver biopsies showed poorly differentiated, mammary adenocarcinoma that was ER-, PgR- and HER2- (triple-negative) with Ki67 staining 70%
• She began first-line chemotherapy with doxorubicin

In February of 2015, she returns with increasing fatigue and back pain; her CT scan shows progression of the hepatic lesions, and bone scan shows new lesions in the T4 and T5 vertebra. At the time of progression, her ECOG performance status (PS) is 1.

• She began therapy with docetaxel plus capecitabine as part of a clinical trial and her disease stabilized after 5 cycles

In June of 2015, she returns for follow up with worsening back pain and intermittent dyspnea. Her CT scan at the time of progression shows the bone lesions worsening and several new bilateral pulmonary lesions.

• Patient remains active, with good liver and renal function; her ECOG PS remains at 1
• The oncologist initiates therapy with eribulin at a dose of 1.4 mg/m2; she tolerates the therapy well and shows a partial response after 5 cycles, with improvement of the bone and pulmonary lesions, and stable hepatic disease