Patient Case Presentation: A 47-Year-Old Woman With HER2+ mBC and CNS Progression
Panelists discussed a complex case of a 47-year-old woman with metastatic HER2-positive breast cancer, emphasizing the importance of continuous systemic therapy despite treatment interruptions, the critical role of multidisciplinary care for central nervous system involvement, and the need to balance efficacy with quality of life as patients navigate prolonged disease courses and evolving treatment strategies.
This case highlights the complexity of managing HER2-positive metastatic breast cancer (mBC) over a prolonged period. The patient, a 47-year-old woman, initially presented with an advanced tumor and metastatic disease involving the liver, bone, and lymph nodes. She received standard induction chemotherapy with docetaxel, trastuzumab, and pertuzumab, achieving a complete metabolic response, followed by maintenance therapy. Despite a period of treatment interruption and local regional management including mastectomy, her disease recurred multiple times over several years, demonstrating the challenges of controlling metastatic disease and the importance of continued systemic therapy.
The patient’s disease course included treatment with trastuzumab deruxtecan (T-DXd) after liver progression, yielding near complete response and extended disease control. Notably, anti-estrogen therapy was introduced later in her course, reflecting a nuanced approach tailored to her disease characteristics and preferences. Eventually, she developed symptomatic brain metastases requiring steroids, ventriculoperitoneal shunting, and stereotactic radiation, illustrating the need for multidisciplinary care and evolving treatment strategies as the disease progresses. This underscores the reality that despite advances, central nervous system (CNS) involvement remains a significant challenge in this population.
The discussion raised several important management points. While some treatment decisions were influenced by patient preferences—such as local surgery and temporary therapy discontinuation—there was consensus on the importance of continuous systemic treatment in metastatic HER2-positive breast cancer. The variable patient experiences with treatment-related adverse effects, especially nausea and vomiting, were acknowledged as key considerations affecting quality of life and treatment adherence. Finally, the case emphasized the remarkable survival some patients achieve with modern therapies, even while living with metastatic disease, highlighting both progress and ongoing unmet needs in care.
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