William J. Gradishar, MD: Chemotherapy Combinations with TNBC

Dr. Gradishar says that at the present time, evidence-based decision making would provide little differences in approach to chemotherapy recommendations between TNBC and non-TNBC. For most patients, single agents in sequence are appropriate, while for those with rapidly progressive disease or a visceral crisis, combination therapy could be considered. Emerging data suggests that platinum-based therapy may be useful in TNBC.

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