HER2+ BC: Residual Disease After Neoadjuvant Therapy
HER2+ BC: Residual Disease After Neoadjuvant Therapy
Case: A 49-Year-Old Woman With HER2+ Breast Cancer
H & P
- A 49-year-old woman was referred by gynecology for a mass in her right breast
- No children, menopause at age 45
- No history of cardiovascular disease, otherwise good health
- PE: revealed a woman of normal weight (BMI = 21 kg/m2), with a palpable mass in her right breast
Imaging
- Mammogram revealed 3.5-cm tumor in right breast
- CT: confirmed a tumor in right breast with no lymph node involvement
Biopsy and labs:
- Histology: ductal, grade 2
- ER(-), PR (-)
- HER2IHC: 3+
- BRCA1/2: negative
Treatment
- Diagnosed with ER/PR negativeHER2+ breast cancer; she received neoadjuvant TCH-P (docetaxel + carboplatin + trastuzumab + pertuzumab and achieved a partial response
- Residual disease of 1.5 cm after neoadjuvant therapy
- Underwent mastectomy
- After discussing with her the options for adjuvant therapy, benefits and risks of each, and her goals, she was started on ado-trastuzumab emtansine (T-DM1)
- At present, she has completed 3 cycles of T-DM1
- Reports numbness in her fingers, “like wearing gloves” that sometimes interferes with small tasks like buttoning a shirt
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