A 27-year-old female smoker of two/three cigarettes/day since she was twenty.
Menarche at age 7.
Get pregnant at age 16.
Five pregnancies (three cesarean sections and two miscarriages).
Use of oral contraceptives for three years.
In December 2013, the patient presented cutaneous edema covering the entire right breast, vesiculated, and painful cutaneous exploration, right axillary and left adenopathy.
You have discomfort in your right breast, rib and submammary area.
SE 2 as general condition.
The necessary tests were performed to determine the stage of the neoplasia.
Laboratory tests showed Fe: 26 μg/dL (RN: 50-170 μg/dL), STI: 9% (RN: 25-50
Ca 15 3: 92.2 IU/mL (RN: < 32.4 IU/mL) with normal blood count.
A core needle biopsy, a skin punch and a positive Hercep Test® (HER 2 +) were performed. PET-CT described the presence of tumor tissue at the level of the right axillary lymph node in the right breast.
Therefore, the patient was diagnosed with ductal carcinoma G2 cT4d cN1 M1 (bone, lymph node and liver) stage IV, breast pain and major secondary wound syndrome a.
Pertuzumab was proposed as the treatment of choice for HER2 + metastatic or locally recurrent unresectable breast cancer in combination with trastuzumab and docetaxel4.
Echocardiography was performed for monitoring cardiac function with a normal LVEF value 63.9%, as it could be affected by trastuzumab and pertuzumab, and MRI was considered a benefit to rule out brain metastases.
The proposed treatment scheme was: pertuzumab 840mg (initiation)/420mg (maintenance), trastuzumab 8mg/kg (initiation)/6mg/kg (maintenance).
Antineoplastic doses were calculated according to weight (88kg) and body surface area (1.95 m2).
The start of docetaxel treatment was tapered by an immediate systemic reaction to docetaxel infusion in the presence of dyspnoea and dizziness, requiring paracetamol, hydrochlorothiazide to administer a protocol, lorazepam and subsequent assessment by the treating physician
The patient was admitted to the ICU on a scheduled basis the following day for administration and thus complete the QT treatment.
Three solutions of the medication (each one of 250 mL 0.9% NaCl) were used for consolidation therapy: A, B and C, which were administered in twelve consecutive steps with increasing infusion rate.
Solution A contained 1/100 dilution of the final target concentration (steps 1-4) and solution B 1/10 dilution of the final target concentration (steps 5-8).
The remaining dose of solution C (150 mg/250 mL) was calculated by subtracting the accumulated dose to the total dose to be administered to the patient.
Each step 1 to 11 was administered within 15 minutes (dosing was increased by 2 - 2.5 times with each step) and step 12 was prolonged to complete the target dose of 150 mg.
The patient presented a partial response after the first cycle with evident improvement of the affected breast since a decrease of its volume was observed without the presence of the previous necrotic aspect.
After the sixth cycle, PET-CT showed absence of metabolic activity in the right breast and axillary lymph nodes, as well as in the bone and liver, with very good metabolic and functional response to treatment.
Currently, after the eighth cycle there is no progression of the disease.
