Abstract
Metastatic hormone-receptor and HER-2 positive (triple-positive) breast cancer provides a treatment dilemma for oncologic clinicians. The current National Comprehensive Cancer Network (NCCN) Guidelines offer a variety of options in the first and second line for metastatic breast cancer. However, a more tailored treatment approach may be needed for the triple-positive metastatic breast cancer population. The aim of this study is to trend the therapeutic treatment selections for patients with metastatic, triple-positive breast cancer at a single, academic-affiliated community practice in the United States. The patient population included individuals with triple-positive, metastatic breast cancer who were treated over the span of six years at this institution. Ultimately, this patient population demonstrated variability across the various treating oncologists choice of therapy in the first, second and fourth line of treatment. The majority of patients (twelve out of fifteen) received combination therapy with trastuzumab in the first line of therapy. In the second line, seven out of eight patients received trastuzumab as part of their treatment regimen. In the third line, all three patients received trastuzumab emtansine as part of their therapy regimen. For patients who were able to survive until the fourth line and beyond, several other treatment options were utilized. Therefore, although metastatic, triple-positive breast cancer represents a subset of patients with vast treatment variability throughout the various lines of therapy, and there is a general lack of consensus on how to best treat this patient population. This study provides an opportunity for more expansive research in the field in order to help elucidate a treatment algorithm for all oncologic practitioners for patients with triple positive, metastatic breast cancer.
Highlights
Breast cancer is the most common cancer diagnosed globally as well as the most common cancer amongst women [1]
A total of 206 patients who were treated between the years of 2010 to 2016 in one, academic-affiliated, community center with metastatic breast cancer were identified
A retrospective chart analysis demonstrated that 15 of these metastatic breast cancer patients were identified as HER2 and hormonal receptors (HR) positive, or triple positive
Summary
Breast cancer is the most common cancer diagnosed globally as well as the most common cancer amongst women [1]. In the United States, breast cancer remains one of the leading causes of cancer related deaths in women [2]. The specific etiology of breast cancer is unknown, many risk factors have been identified and include; female gender, increasing patient age, family history of breast cancer at a young age, early menarche, late menopause, nulliparity, prolonged hormone replacement therapy, previous exposure to chest wall radiation (typically seen ages 10-30 for treatment of Non-hodgkins lymphoma), benign proliferative breast disease, and genetic mutations. Upon tissue diagnosis of breast cancer, all patients are assigned a clinical stage of disease that allows for identification of treatment options and for risk stratification to determine the patient’s disease prognosis. In non-metastatic breast cancer, surgery can often be curative for localized tumors while systemic chemotherapy with or without radiation can help shrink and
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