Sustained OS on Palbociclib in MBC
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A 58-year-old female with metastatic breast cancer underwent a treatment regimen including palbociclib and showed exceptional progression-free survival over six years, receiving 73 cycles. Throughout her assessments, various tumor markers indicated stable disease and responses, with the last assessment in October 2022 showing no active disease. The consistency of treatment and the specific protocol followed contributed significantly to her remarkable outcomes.
Sustained OS on Palbociclib in MBC
- 1. Sustained Overall Survival on Palbociclib in Metastatic Breast Cancer f CDK 4/6 Inhibitors in the Palestinian Setting Presented by: Hasan Arafat, Medical House Officer Augusta Victoria Hospital
- 2. • A 58-year-old female patient, with an unremarkable past medical history, presented to an orthopedic clinic in late 2016 complaining of right lower limb pain. • MRI showed a femoral mass, suspicious in nature. • Whole-body CT: huge right breast mass with suspicious liver lesions • Histopathology of breast biopsy: IDC grade III. • Diagnosed as having metastatic breast cancer to bone, liver, ER +, PR +, Her2 -, Ki67: 30% • Baseline tumor markers: CEA: 26, CA 15.3: 48
- 3. • Plan by medical oncology: • For palliative breast radiation, in addition to femoral fixation • To start goserelin, tamoxifen • Request a CDK 4/6 inhibitor (palbociclib) • Add denosumab
- 4. • On the 17th of November 2016, the patient started on the following regimen: • Tamoxifen, 20 mg PO OD • Goserelin, 10.8 mg SQ q3 months • On the 28th of November, the referral request for a CDK 4/6 inhibitor was accepted, so the patient was started on palbociclib, 125 mg PO OD
- 5. • Her first assessment took place in February 2017, CT was suggestive of response, manifesting as a decrease in the size of the breast mass and the bony lytic lesions becoming sclerosed, with no definitive new lesions • CA 15.3: 11.39, CEA: 7.65 • Continued on the same regimen
- 6. • The second assessment was in June 2017, showed stable disease. • CA 15.3: 11.61, CEA: 6.18 • The patient received a total of 8 months of tamoxifen, then switched to letrazole, 2.5 mg PO OD, starting July 2017 • Otherwise continued on the same regimen
- 7. • Palbociclib was held for 1 month (September 2017) due to neutropenia, 700 • Resumed in October • The third assessment, in November 2017, showed response, negative tumor markers (CA 15.3: 12, CEA: 5) • Clinically, the patient was completely asymptomatic • The fourth assessment took place January 2018, CT showed a great response, while tumor markers were negative (CA 15.3: 17, CEA: 3.8)
- 8. • The fifth assessment took place in June 2018, showing a stable metastatic disease, tumor markers were negative. • Sixth assessment, in November 2018, showed a stable disease, with negative markers (CEA: 3.4, CA 15.3: 14.92). • Seventh assessment, April 2019, stable disease with negative tumor markers • Eighth assessment, July 2019, stable CT scan, CA 15.3: 14, CEA: 3.4 • Ninth assessment, December 2019, stable scan, negative tumor markers
- 9. • The tenth assessment was made relatively late in August 2020 due to COVID-19 closure, the scan showed a stable metastatic disease with negative tumor markers. • Continued on the same regimen • Eleventh assessment, March 2021, stable scan • Goserelin was stopped as the patient reached menopause • Assessment twelfth, August 2021, stable scan • Assessment thirteenth, January 2022, stable scan • Assessment fourteenth, July 2022, stable scan
- 10. • Last assessment in October 2022, fifteenth in total, via PET scan: • Inactive sclerotic lesion on D9 • Severe degenerative changes in the lumbar region with disc sequestration in L2-L3 • No evidence of active disease
- 18. Conclusion • In total, our patient has received 73 cycles of Palbociclib over 6 years • This constitutes an exceptionally long progression-free survival for a patient with metastatic breast cancer • The unusual consistency by which the patient received her regimen is one major factor behind her remarkable response. • Now, what is the next step?
Editor's Notes
- #3: Our case is a 64-year-old female, with a free past medical history. Our lady presentedin late 2016 to an orthopedic clinic complaining of pain and swelling in her right lower limb. Her orthopedist ordered an MRI, which showed an ugly mass, suspicious in nature