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 outcomes
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 2 nd 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
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