Case Study: HER2-Positive Oligometastatic Breast Cancer

Panelists: Kimberly L. Blackwell, MD, Duke; Adam M. Brufsky, MD, PhD, University of Pittsburgh;
Joyce A. O’Shaughnessy, MD, US Oncology; Mark D. Pegram, MD, Stanford; Hope S. Rugo, MD, UCSF;
Denise A. Yardley, MD, Sarah Cannon
 
Published Online: Thursday, April 24, 2014
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In a case-based discussion, moderator Adam M. Brufsky, MD, PhD, describes a 40-year-old woman with a 2 cm mass in her left breast and a single 2 cm metastatic liver lesion. A biopsy of the left breast reveals the tumor is estrogen receptor (ER)-positive and HER2-positive. A biopsy of the liver indicates that it is HER2-positive and ER-negative.

The majority of the panel agrees that a combination regimen of docetaxel, trastuzumab, and pertuzumab (THP) is ideal for this scenario. Joyce A. O’Shaughnessy, MD, suggests that carboplatin should also be administered, since it appears to be oligometastatic disease that could be amenable to a curative therapeutic strategy. Moreover, the addition of a DNA damaging agent, like carboplatin, appears to be beneficial in the setting of ER-negative disease, O’Shaughnessy notes.

Depending on the response to the combination therapy, a hepatic metastasectomy could be performed following the completion of treatment, believes Hope S. Rugo, MD. An optimal strategy may include treatment with the 4-drug combination followed by docetaxel plus trastuzumab or trastuzumab plus pertuzumab with an assessment of the metastatic site at 6 to 12 months, suggests Brufsky. At this point, if the lesion is still present, metastasectomy is a reasonable option.
View More From This Discussion
Episode 1 Overview of HER2-Targeted Therapies in Breast Cancer
Episode 2 Treating Low-Risk HER2-Positive Breast Cancer
Episode 3 Frontline Pertuzumab for Metastatic Breast Cancer
Episode 4 PIK3CA Mutations in HER2-Positive Breast Cancer
Episode 5 T-DM1 in HER2-Positive Metastatic Breast Cancer
Episode 6 Recommendations for Optimal HER2 Testing in Breast Cancer
Episode 7 Role of Lapatinib in HER2-Positive Breast Cancer
Episode 8 Novel Drug Development in Breast Cancer
Episode 9 Phase III Clinical Trials in HER2-Positive Breast Cancer
Episode 10 Case Study: HER2-Positive Oligometastatic Breast Cancer
Episode 11 Upfront Treatment of HR-Positive MBC
Episode 12 Next Steps for Everolimus in Metastatic Breast Cancer
Episode 13 CDK4/6 Inhibitors in Metastatic Breast Cancer
Episode 14 Chemotherapeutics in Metastatic Breast Cancer
Episode 15 Preventing Skeletal-Related Events in Breast Cancer
Episode 16 Conclusion: Future Direction of Breast Cancer Treatment
Expert Panelists
Dr Adam Brufsky

Adam M. Brufsky, MD, PhD

Moderator
Professor of Medicine, University of Pittsburgh
Medical Director of the Women’s Cancer Center at Magee-Womens Hospital of UPMC and the University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania
 
 

Kimberly L. Blackwell, MD

Professor of Medicine
Assistant Professor in Radiation Oncology
Duke Cancer Institute
Durham, North Carolina

Joyce A. O’Shaughnessy, MD

Co-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Dallas, Texas
 

Mark D. Pegram, MD

Professor of Medicine (Oncology)
Stanford University Medical Center;
Susy Yuan-Huey Hung Professor;
Associate Director of Clinical Research and Director, Breast Cancer Program, Stanford Cancer Institute, Stanford, California

Hope S. Rugo, MD

Professor of Medicine and Director of the Breast Oncology, Clinical Trials, and Education Program, University of California San Francisco Comprehensive Cancer Center, San Francisco, California
 

Denise A. Yardley, MD

Senior Investigator, Breast Cancer Research
Sarah Cannon Research Institute, Tennessee Oncology, Nashville, Tennessee
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