Maria, a 57-year-old postmenopausal Caucasian woman had a routine mammography screening 2 years ago and was found to have an architectural distortion in the upper outer quadrant of her left breast. A core needle biopsy revealed an invasive ductal carcinoma, estimated by imaging to be a T1 lesion. She underwent a lumpectomy/sentinel lymph node biopsy that revealed a 1.5-cm invasive ductal carcinoma that was estrogen receptor (ER)-negative, progesterone-receptor (PR)-negative, human epidermal growth factor receptor 2 (HER2)-positive cancer by fluorescence in situ hybridization (FISH), with a Ki-67 value of 25%. No cancerous tissue was found to be involved in a dissection of 2 sentinel lymph nodes.
Maria received radiation therapy and adjuvant chemotherapy with targeted trastuzumab therapy for 1 year. However, during her 2-year follow-up visit, Maria complained of excessive cough and mild shortness of breath. Her oncologist immediately ordered a chest CT scan, which revealed mild left pleural effusion and multiple nodules (up to 1 cm) in the left, middle, and lower lobes. Immunohistochemistry (IHC) of her biopsy confirmed ER-/PR-/HER2 3+. Other metastases were not observed in CT or bone scans.
Maria and her daughters met with her medical oncologist to discuss the diagnostic findings and the next steps for treatment. Concerned and confused about why her initial treatment did not work, Maria and her daughters posed multiple questions to the oncologist:
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