►Personal History
-Premenopausal Female 44 y.o
-Abnormal mammogram 2 months ago
-Core biopsy ductal carcinoma
-Mastectomy and 1.4 cm tumor recovered
-T3N0M0 (stage IIB)
-ER/PR+ & HER3+
-Schedule to receive radiation
-Needs adjuvant pharmacological therapy
►Medical History- Breast carcinoma – newly diagnosed
- Hypothyroidism
►Family and Social History
-Family history – Mother: ovarian cancer diagnosed in 40s Maternal aunt: breast cancer diagnosed in 40s
► Social history – Single mother with twins (12 years old) - Smoked 1/2 pack per day for 6-7 years
– Quit 3 years ago
– Rare alcohol use
►Patient risk factors – Female, family history, age, Smoking, childbirth after age 30
►Physical Examination
- No visual disturbances
- Denies headaches
- No weight loss and no appetite changes - Scars on breasts from mastectomy
- No palpable lymph node
-Thyroid normal size
►Medications and allergies
-Acetaminophen- joint pain
Thyroxine- Hypothyroidism
Orthocyclen- Contraception
Allergies- Morphine Rash
►Diagnosis- Stage IIB – early-stage breast cancer - T3N0M0
►Treatment plan
-Chemotherapy+trastuzumab+Endocrine therapy
Adjuvant Chemotherapy
-AC (doxorubicin + cyclophosphamide) ± pertuzumab THEN Paclitaxel WITH trastuzumab
-Premenopausal at diagnosis – Tamoxifen 5 years ± ovarian suppression OR – Ablation – Further treatment based on menopausal status
-Postmenopausal at diagnosis – Aromatase inhibitor for 2 to 3 or 5 years OR – Tamoxifen for 2 to 3 years
- Paclitaxel 80mg/m2
- 150.4 mg IV infusion once a week x 12 doses over 1 hour
-Trastuzumab
-Week 1 – loading dose of 4 mg/kg (312 mg) IV infusion over 90 min
-Next 11 weeks – 2 mg/kg (156 mg) IV infusion over 30 min weekly
-At week 13 to week 52
-Trastuzumab 6 mg/kg (468 mg) IV infusion over 30 min Q 3 weeks
-At week 13
-Tamoxifen 20 mg PO QD x 5 years
-Reevaluate at 5 years - based on menopausal status