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ESMO Preceptorship Programme
Cristina David
Medical Oncology Resident
Coltea Clinical Hospital
Bucharest
Case presentation
Metastatic Breast Cancer
ESMO Perceptorship on Breast Cancer 2017, Lisbon, Portugal 10-11 nov.2017
ESMO PRECEPTORSHIP PROGRAM
Patient΄s History
NF, female, 58 years old
Family history-no family history of breast or
ovarian cancer
Past medical history-no relevant past medical
or surgical history
Gynecologic-obstetric history-non relevant
ESMO PRECEPTORSHIP PROGRAM
Patient΄s History
09/2014-breast lump in the upper outer quadrant
Mammography-30 mm infiltrative nodule in the upper outer quadrant, BIRADS 3.5
Core Biopsy-invasive carcinoma,Grade 3, ER 80%, PR 20%, HER2/neu-negative, Ki67-60%.
CA15-3- 49.9 u/ml, CEA- normal value
Bone scan-negative
ESMO PRECEPTORSHIP PROGRAM
First line treatment -1
Chemotherapy- Neoadjuvant setting
September 2014-Fluorouracil 500 mg/sqm
+Doxorubicin 50 mg/sqm +
Cyclophosphamide 500 mg/sqm q3 wks- 8
courses
January 2015- CA15-3-80.1 u/ml
February 2015-two breast nodules in the upper
outer quadrant 4-5 mm. No axillary limph
node involvment.
ESMO PRECEPTORSHIP PROGRAM
March 2015- Left breast radical mastectomy
HP-invasive carcinoma,Grade 2, ER 80%, PR 70%, HER2/neu-
negative, Ki67-10%, R0, 15 lymph nodes invaded from 17 lymph
nodes examined. ypT2 ypN3a Mx stage IIIC Luminal B-like
Source-https://www.cancer.gov/types/breast/surgery-choices
ESMO PRECEPTORSHIP PROGRAM
Bone scan after surgery- suspicious bone
lesion on the 6th left posterior costal arch
April 2015► Letrozole started CA15-3-56.3
u/ml
Letrozole continued up to February 2016
Second line treatment- 2
Endocrine therapy –Adjuvant setting
ESMO PRECEPTORSHIP PROGRAM
Adjuvant Radiation Therapy June-July 2015- External beam radiotherapy
on thoracic wall, 50 Gy, left axilla 50 Gy
Source-http://www.breastscancersymptoms.com/breast-cancer-treatment/radiotherap
y-for-breast-cancer/
ESMO PRECEPTORSHIP PROGRAM
Second line treatment- 3
Endocrine therapy-Metastatic setting
Febr 2016-Bone scan-bone lesion on the 6th
left posterior costal arch, new lesions at the left
iliac bone, left femural neck.CA15-3- 142
u/ml
PET/CT- metabollicaly active bone lesions
vertebral body L5, S1,S2, right acetabulum
Febr 2016-July 2016 – Exemestane +
Biphosphonates
ESMO PRECEPTORSHIP PROGRAM
Third line treatment-3
Endocrine therapy-Metastatic setting
July 2016-CA15-3-449 u/ml, bone scan- new
lesions right scapula, left ischium, sacroiliac
joints►progression M1OSS
July-October 2016—Fulvestrant +
biphophonates
ESMO PRECEPTORSHIP PROGRAM
Palliative Radiation Therapy
Lumbar spine and pelvic bone pain-August 2016-
Palliative radiation therapy , TD-20 Gy
By Mikael Häggström -Own work, CC0, https://commons.wikimedia.org/w/index.php?curid=54552293
ESMO PRECEPTORSHIP PROGRAM
Fourth line treatment-4
Chemotherapy- Metastatic setting
October 2016- CA15-3-1400 u/ml, CT and
bone scan reveal progression of bone
metastases (3rd costovertebral joint, greater
trochanter)
Change to palliative chemotherapy with
Docetaxel 80 mg/sqm (October 2016-April
2017)+ Biphosphonates
ESMO PRECEPTORSHIP PROGRAM
Fifth line chemotherapy-5
Chemotherapy-Metastatic setting
april 2017-neurological evaluation-Grade 3
peripheral neuropathy
CA15-3-1010 u/ml, CT –stable disease
Change chemotherapy with Capecitabine
1000 mg/sqm + biphosphonates (april 2017-
august 2017)
ESMO PRECEPTORSHIP PROGRAM
Sixth line chemotherapy-6
Chemotherapy –Metastatic setting
August 2017- Thoracic-abdomen-pelvis CT-
progression M1OSS, MIPUL, M1LYM,
CA15-3-1470 u/ml
Cardiac evaluation –LVEF- 60%, normal ECG
Change chemotherapy with Liposomal
doxorubicin 40 mg/sqm + Biphosphonates
(August 2017-in course)
ESMO PRECEPTORSHIP PROGRAM
