44-Year-Old Female with Locally Advanced Breast Cancer
Nancy, a 44-year-old woman of five, was referred for treatment of locally advanced breast cancer. She had a massive tumor with skin thickening in her right breast. Ultrasound was used instead of mammography due to the hardness of her right breast — revealing pronounced skin thickening, an indistinct mass, and enlarged axillary lymph nodes.
Positron emission tomography revealed no visceral metastases but swelling of the axillar, parasternal, and supraclavicular lymph nodes.
Core needle biopsy showed the primary tumor as luminal — ER-positive, PR-negative with an Allred score of 8. Fine-needle aspiration cytology of the axillar lymph node affirmed metastatic disease.
Is primary endocrine therapy with palliative intent the only option for patients like Nancy?
Is there a pathway for curative intent for this patient?
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Breast Cancer ConnectMay 21, 2021Thanks for your input, [~DONALD--FLEMING--dfleming1@ ] and [[email protected]] ! In their responses, both active cancer treatment and palliative care were mentioned. What are your thoughts? Please share.
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Naveed Saleh, MD, MS – Skipta TeamMay 21, 2021Thanks for your input [~DONALD--FLEMING--dfleming1@ ] and [[email protected]] ! In their responses, both active treatment and palliative care were mentioned. What are your thoughts? Please share.
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DONALD FLEMINGMay 19, 2021Assuming since not mentioned, the breast cancer is Her negative, I would try induction chemotherapy dd AC + T followed by adjuvant hormonal therapy with post menopause status either present or induced and in addition to surgery will requires modified radical surgery and XRT to primary disease. Remains to be seen whether adding CK4/6 is needed with AI =/- LHRH agonist, but some early data suggests benefit.
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Gregory GuzleyMay 19, 2021With parasternal and supraclavicular adenopathy, chance of cure is minimal, and would require induction chemotherapy, surgery only if there was a really exceptional response, chest wall, internal mammary, supraclavicular irradiation, and post op adjuvant therapy, probably with chemotherapy followed by extended adjuvant. I would tell the patient that after going through all that, the chance of the disease recurring would still be >95%. Since she is young, she may want to consider that approach, and, if so, I would refer to a specialized center. If she were not motivated to undertake that approach, palliative endocrine therapy for ER + locally advanced disease would be appropriate.