|
You are here: Home: BCU 4|2002: Program Supplement: Case 5
Miami Breast Cancer
Conference
Tumor Board Case 5: Stephen Jones, MD
A patient with rapidly
recurring metastatic breast cancer |
|
| The patient is a 58-year-old woman
treated 9 months ago for a 3 cm, ER-negative, PR-negative,
infiltrating ductal carcinoma. She underwent lumpectomy,
axillary dissection and radiotherapy and had 20 positive
lymph nodes. She was treated with high-dose chemotherapy
(including induction AC) with bone marrow transplantation.
She now presents 9 months later with multiple bilateral
bulky cervical, supraclavicular and mediastinal lymph
nodes. What is your treatment recommendation?
She was treated with capecitabine/docetaxel and had
a complete response but developed hand-foot syndrome.
The capecitabine was discontinued, and the patient remains
in remission. Would you stop the docetaxel?
|
|
 |
 |
Two-thirds of the attendees would utilize combination chemotherapy
with capecitabine/ docetaxel (X-T), which has been demonstrated
in a randomized trial to improve survival compared to docetaxel
alone. The short disease-free interval in this patient and the rapid
appearance of bulky metastases after high-dose chemotherapy suggests
a poor prognosis.
This patient was treated several years ago as part of the X-T
trial. She was randomized to receive the combination of capecitabine/docetaxel.
After 4 courses of therapy, she had a complete tumor response. The
patient developed hand-foot syndrome but delayed reporting it to
Dr Jones. By the time she presented, she had grade 3 toxicity. The
capecitabine dose was decreased, and eventually the drug was discontinued.
The patient has been maintained on low-dose docetaxel. She continues
in complete remission. In view of the minimal treatment - related
morbidity, the unanimous opinion of the faculty was to continue
docetaxel.
Vukelja SJ et al. Xeloda (capecitabine) plus docetaxel combination
therapy in locally advanced/metastatic breast cancer: Latest results.
Breast Cancer Res Treat 2001; Abstract
352.
|
|
