DR PEREZ: This is 52-year-old female who presented with metastatic HER2-positive breast cancer to the lungs. The patient had an excellent performance status. The pathology, reviewed at Mayo, verified that, indeed, the tumor was HER2-positive. So a decision had to be made related to how we were going to manage her.
DR LOVE: And can you talk a little bit more about how she presented? And was there a mass in the breast?
DR PEREZ: There was a mass in the breast. And the patient had some dyspnea, and that was how the disease was uncovered.
DR LOVE: And what was the extent — you said she had dyspnea — of the lung involvement?
DR PEREZ: The patient was actually an active runner. And the patient started noticing that she couldn’t run as fast as she used to. And that’s how this was found, actually.
DR LOVE: On imaging, how extensive was it?
DR PEREZ: She had some infiltrate in the lungs that was noted. But the lesions actual were not that big. There may have been some lymphangitic spread that was observed.
DR LOVE: Sounds a little bit scary. Ruth, what would you be thinking about in this 52-year-old lady presenting with metastatic disease?
DR O'REGAN: I think, based on the data we have available, the best regimen would be pertuzumab/trastuzumab and docetaxel. And that’s what I would give her.
DR LOVE: Bill?
DR GRADISHAR: This patient nicely fits the CLEOPATRA criteria with trastuzumab-naïve. I would give her the CLEOPATRA regimen.
DR LOVE: Sara?
DR HURVITZ: I agree.
DR LOVE: Hope?
DR RUGO: I agree. I would continue the chemo until good response and then drop the chemo.
DR LOVE: Lisa?
DR CAREY: I agree.
DR LOVE: What would you be thinking about, Adam?
DR BRUFSKY: Sara and Edith’s publication — I mean, that’s pretty compelling evidence, even though it’s a small Phase II trial. We all understand this. But that’s pretty compelling because in that trial the trastuzumab/docetaxel arm is exactly what you saw from the Marty data. There’s no selection bias or anything like that. It’s pretty good.
That being said, I think I would have a hard time getting it approved by insurance for somebody, so that would be the practical reason I couldn’t give it. I would do THP. I’m going to agree with everybody else. Give her that.
DR LOVE: Edith, what happened?
DR PEREZ: We enrolled the patient on the MARIANNE trial. To recap, MARIANNE has 3 arms — taxane in combination with trastuzumab, where we allow either docetaxel or paclitaxel based on physician’s preference. The second arm, that has T-DM1 alone or T-DM1 with pertuzumab, where the pertuzumab is actually also as part of placebo. We don’t know what arm of T-DM1 the patient was randomized to, T-DM1/ placebo or T-DM1 with pertuzumab. This patient was treated in one of the T-DM1 arms. I just don’t know which — if it was T-DM1 alone or the combination. This patient has done very well. She had very fast improvement in the evidence of disease in the lung, as well as her symptoms. She continues on therapy now for 6 months.
DR LOVE: What happened with the breast mass?
DR PEREZ: Shrinking.