Dr P K julka, Former Dean & Professor of Oncology AIIMS, New Delhi, delibrates on how personalised treatment can be an option for cancer patients.
Modern molecular profiling, where patients are characterised into subgroups, is now helping personalise treatment options for cancer patients, opening up new avenues of dealing with the disease. It also provides patients the opportunity to receive minimally-toxic therapy with clinical benefits.
A 61-year-old woman patient was brought with a lump in her left breast and skin ulceration that she had had for six months. A trucut biopsy of the lump showed invasive ductal carcinoma, the most common type of breast cancer.
The patient underwent left-modified radical mastectomy (MRM), removal of the breast including the skin, breast tissue, areola, and nipple, along with axillary node dissection — removal of the lymph nodes from under the arm.
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Histopathology revealed a 5*4 cm mass in the breast; three of the eleven lymph nodes were involved, with tumor emboli in the lymphatics adjacent to the involved nodes. The receptor status ER, PR and Her2neu were negative (Triple negative), a type of cancer that does not respond to hormone therapy.
The patient received adjuvant chemotherapy (additional treatment given after surgery to lower the risk of the cancer returning) consisting of four cycles of Doxorubicin and Cyclophosphamide followed by four cycles of Docetaxel every third week.
She then underwent adjuvant radiation to the chest wall and regional nodes for a total dose of 50 Gy in 25 fractions.
She had two years of disease-free survival but then began to develop lung metastasis (cancerous tumors that start somewhere else in the body and spread to the lungs). She responded partially to several lines of palliative chemotherapy. She subsequently developed bone metastasis and skin deposits.
A biopsy from skin nodules revealed metastatic carcinoma, which was again found to be triple negative and androgen receptor positive.
Her disease continued to progress in spite of she receiving two cycles of Eribulin and palliative radiation to the skin nodules.
She is now on tablet Bicalutamide (150 mg), which she takes orally every day. Its been two months since she was put on the Bicalutamide therapy and her cancer has stabilised.
The case is of interest as triple negative breast cancer is an aggressive form of the disease, known to have the worst prognosis. It also tends to relapse earlier than other breast tumour subtypes.
Modern molecular profiling helped the patient to receive oral endocrine therapy, a new treatment option.