Martha (72 years old)

Martha, 72 years old, received trastuzumab + tucatinib + capecitabine for a duration of 26 months as third-line treatment for HER2+ MBC. She has a follow-up visit today.

Assessment summary

• Postmenopausal
• Medical history:
  • ~4.5 years ago: diagnosis de novo HR- HER2+ MBC
  • Tumour biology (liver lesion): invasive ductal carcinoma, ER 0%, PgR 0%, HER2 IHC 3+
  • First-line treatment for bone, liver and lung metastases:
    • Paclitaxel + trastuzumab-pertuzumab for 10 months
  • Second-line treatment for liver and brain progression:  
    • SRS for the 3 brain metastases
    • Trastuzumab deruxtecan for 14 months without toxicity
  • Third-line treatment for liver progression:
    • Tucatinib + trastuzumab + capecitabine for 26 months with partial response as best response
    • Minor hand-foot syndrome (grade 1) thanks to diclofenac use

She comes to the clinic for new staging:

• ECOG PS: 1
• Biology: AST 2.5x ULN, ALT 2.5x ULN, bilirubin <1.5x ULN
• PET-CT: miliary liver progression
• New liver metastasis biopsy: invasive ductal carcinoma, ER 30%, PgR 0%, HER2 IHC 3+