A 54-Year-Old Woman With Stage 2 HER2+ Breast Cancer

Case: A 54-Year-Old Woman With Stage 2HER2+ Breast Cancer

Initial presentation

• A 54-year-old, postmenopausal woman presented with a painless palpable mass on the right upper outer quadrant of her right breast
• PMH/SH: unremarkable, no family history of cancer
• PE: ~ 4-cm palpable right breast mass, clinically node negative, no visible sink involvement

Clinical workup

• Labs: WNL
• Ultrasound showed a right breast mass, and two axillary lymph nodes
• Mammogram confirmed a right—sided, poorly defined speculated 4.2-cm mass
• PET/CT showed increased uptake in the right breast diffusely, with 2 FDG—avid axillary lymph node involvement; no evidence of distant metastases
• Ultrasound—guided FNA biopsy of the breast mass confirmed grade 3 infiltrative ductal carcinoma
  • Hormone receptor/HER2 Status:HER2+:3+ by IHC,80%ER+, PR-
• Stage T2N1M0; ECOG PS 0

Treatment and Follow-Up

• The patient was started on preoperative docetaxel + carboplatin + trastuzumab + pertuzumab (TCHP), and pegfilgrastim every 3 weeks for 6 cycles;
  • Achieved clinical complete response
• She underwent right mastectomy; residual disease: 1 positive axillary lymph node, and 1-cm RD in the right breast; 4 sentinel lymph nodes removed, 1 positive for disease; she also received post mastectomy radiation therapy of her chest wall and regional lymphatics
• She was started on trastuzumab emtansine every 3 weeks for 14 cycles + aromatase inhibitor PMRT + letrozole planned for 10 years
• Extended adjuvant neratinib was initiated
  • Week 1: 160 mg (4 tablets) PO qDay; week 2: 200 mg (5 tablets) PO qDay; week 3: 240 mg (6 tablets) PO qDay for 1 year
  • IV zoledronic acid every 6 months was added to her regimen for 3-5 years