Case Study: HER2-Positive Oligometastatic Breast Cancer
Published Online: Thursday, April 24, 2014
For High-Definition, ClickIn 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.
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Kimberly L. Blackwell, MDProfessor of Medicine
Assistant Professor in Radiation Oncology
Duke Cancer Institute
Durham, North Carolina
Joyce A. O’Shaughnessy, MDCo-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Mark D. Pegram, MDProfessor 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, MDProfessor 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, MDSenior Investigator, Breast Cancer Research
Sarah Cannon Research Institute, Tennessee Oncology, Nashville, Tennessee
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