Denise A. Yardley, MD: Standard of Care for Patient

Trials such as tnAcity will help determine a standard for patients like Rebecca B., who received appropriate anthracycline- and taxane-based therapy for her early-stage disease and unfortunately relapsed. As she is greater than 12 months from her exposure to a microtubule inhibitor, this remains a reasonable option and backbone to therapy. Given her young age and symptomatic visceral relapse, a clinical trial evaluating combination chemotherapy regimens seems reasonable and appropriate. By assessing regimens that demonstrate non—cross-resistance and offer great therapeutic options for her aggressive TNBC subtype, such as tnAcity, it is hoped that a better understanding of the impact of combination chemotherapy on her disease will establish additional treatment options.

CASE 1: Triple-Negative Breast Cancer

Rebecca B. is a 48-year-old premenopausal African American woman from Tampa, Florida who works as a nursing administrator for a home healthcare company.

In December 2009, patient presented to her PCP after detecting a mass in her right upper-outer quadrant on self exam; she was referred for imaging and further evaluation.

Mammography and ultrasound revealed a 2.5-cm mass

Core biopsy revealed moderately differentiated invasive ductal carcinoma that was ER-/PgR-; HER2 staining was negative by immunohistochemistry

Patient was referred for whole-breast MRI and surgical evaluation

Patient underwent a lumpectomy of the right breast with sentinel lymph node evaluation

Sentinel lymph node evaluation was positive; patient underwent axillary lymph node dissection

Malignant cells were detected in 1 sentinel and 2 axillary nodes (total 3 of 14 LN+); tumor classified as Stage 2B (T2N1M0)

Post surgery, patient received TAC chemotherapy with docetaxel (75 mg/m2 IV day 1), doxorubicin (50 mg/m2 IV day 1), and cyclophosphamide (500 mg/ m2 IV day 1, cycled every 21 days for 6 cycles), with pegfilgrastim support

Patient received radiation therapy for 6 weeks, including ipsilateral breast and regional nodes

Patient remained disease-free for approximately 3 years

In January 2013, the patient returned to her PCP complaining of intermittent right-upper quadrant pain, fatigue, and unexplained weight loss.

A subsequent CT scan revealed visceral metastases in the liver and lung; bone scan was negative

Liver biopsy was performed and specimen was sent for ER, PR, and HER2 determinations