CANCER: EXPERIENCES WITH LOCAL RECURRENCE Cleo Solomon Specialist - - PowerPoint PPT Presentation

TRIPLE NEGATIVE BREAST CANCER: EXPERIENCES WITH LOCAL RECURRENCE

Cleo Solomon Specialist Physician and Medical Oncologist University of the Witwatersrand Charlottle Maxeke Johannesburg Academic Hospital

NO DISCLOSURES

A TALE OF 2 …

Responses to chemotherapy do not seem to have resulted in different

• utcomes

Different responses to NAC have not yielded a better outcome …

Ms S Mrs G 40 y 45 y T4b N3 T4a N2 AC -T TAC pCR Refractory disease

Ms S

• 40 year old premenopausal
• Right triple negative breast cancer
• Ki 67 = 30%
• Invasive carcinoma no special type
• T4b N3
• Metastatic workup (including bone scan and CT chest/Abdo) were negative
• HIV negative.

• Received 4 cycles AC followed by 5 cycles of paclitaxel (extended Taxol component

due to excellent ongoing response and desire to reach resectability if possible)

• Right mastectomy and ALNDx on 15/10/2018
• 2 lymph nodes were resected, both found to be negative
• No residual invasive tumour was found (complete pathological response)
• Referred for radiation.

• Contralateral axillary lymphadenopathy developed as well as local recurrence in

December of 2018 : stage 4 disease

• Repeat CT staging and bone scan is pending.
• Patient screened for trial recruitment and failed screening.
• Will be started on 2nd line chemotherapy with palliative intent.

Mrs G

• 45 year old premenopausal
• T4a N2
• Triple negative left sided breast cancer Ki 67 = 40%
• No family history of breast cancer.

• Received TAC : total of 4 cycles were given.
• Progression was noted after cycle 4 with a left supraclavicular lymph node now

being palpable.

• CT scanning and bone scans showed no metastatic disease : patient was not

eligible for any of the trials available at that time.

• Second line chemotherapy was started : Cisplatin and Gemcitabine: 6 cycles

Mrs G

• Left mastectomy and ALNDx 24/02/2017
• 75mm tumour
• Metaplastic carcinoma with squamous differentiation
• Closest resection margin : 3mm (inferior).
• No therapeutic effect found (Sataloff scoring)
• 3/13 Lymph nodes involved.
• Ki67 = 40%

Mrs G

• Radiation: 04/07/2017 – 04/08/2017
• Left tans/axilla/supraclav
• 44Gy / 22 #
• Photons
• New lymph node was noted to be palpable on 11/07/2017 – biopsy proved

recurrence (authorized on 27/07/2018)

Mrs G

• Still no metastatic disease on workup and no trials available in the setting of local

recurrence only

• Extensive discussion: node was very close to axillary artery and therefore it was

irresectable.

• Palliative radiation to the left axilla was given in an attempt to reduce the lesion:

well tolerated and caused some local response

• Metastatic disease then documented in November 2017 with lung, pleural, and

boney mets.

• Succumbed to illness in December of 2017

Suggested questions

• How do we improve the outcomes in patients with locally advanced triple negative

breast cancer?

• How do we predict which patients will have disease refractory to chemotherapy?

QUESTIONS