Inés (35 years old)

Inés is a 35-year-old woman, who stopped adjuvant treatment for early breast cancer 3 months ago. At the follow-up visit, she presents with chest pain and stage II dyspnoea, which she experiences since the last 2 months.

Assessment summary

• Premenopausal
• No relevant comorbidities
• ECOG PS: 1
• Medical history
  • 18 months ago: diagnosis of stage II early breast cancer (cT3N0M0)
  • Tumour biology (breast lesion): invasive ductal carcinoma, G3, Ki67 40%, ER 100%, PgR 10%, HER2 IHC 3+
  • Neoadjuvant sequential chemotherapy + dual HER2-blockade
  • Lumpectomy and sentinel lymph node dissection (pCR: ypT0N0)
  • Adjuvant treatment: maintenance dual blockade (trastuzumab-pertuzumab every 3 weeks for 14 cycles, stopped 3 months ago) and ongoing endocrine therapy (AI + LHRH analogue)
• Clinical exam: suspicion of bilateral pleural effusion
• PET-CT: bilateral pulmonary metastasis with bilateral pleural effusion without lymphangitis associated with hepatic bilobular metastasis
• Liver biopsy: breast cancer (invasive ductal carcinoma), ER 100%, PgR 10%, HER2 IHC 3+, Ki67 25%