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carmenlynn3 View Drop Down
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    Posted: Apr 15 2021 at 4:27pm
HI, MY mom diagnosed with metastatc triple negative. Family has palb gene.   She has had 3 separate cases of breast cancer, 2 were tn.  Last one 2 years ago came back recently in liver, lungs, bone and possibly brain.

Receiving first treatment today at Mayo Phoenix, We would appreciate any input on her treatment, suggestions etc. 

Treatment plan, April 2021
 there will be 6, 28 day cycles with weekly chemo.  Each visit includes Tezolizumab, and day 8 will also add Abrazane/paciltaxol

74 y.o. female with a history of clinical stage I (cT1ccN0cM0, ER-, PR-, HER2-, grade 3) upper inner left breast cancer, now with metastases to lung and liver.

HISTORY OF PRESENT ILLNESS

She was on clinical trial: RU011501 folate receptor alpha vaccine. She has started to developed some dyspnea on exertion and shortness of breath, in particular in her right lower lobe. Evaluation led to imaging, and identification of a large left lower lobe necrotic lung mass, with regional adenopathy. He was not clear if this was a primary lung cancer or a metastatic lesion. She does have a long history of tobacco use. She was also found to have multiple liver lesions. She underwent biopsy of both, final pathology was consistent with metastatic triple negative breast cancer. PDL1 testing of the liver lesion showed 1% reactivity by immunohistochemistry.

ONCOLOGIC HISTORY
Oncology History Overview Note
She reports in 1997 she developed left breast DCIS which was identified on screening mammography. We do not have the record of receptor status. She received lumpectomy followed by radiation.

The patient otherwise was healthy until 2005 when once again on screening mammography she was found to have a right breast mass. This was biopsy proven to be invasive ductal carcinoma ER negative, PR negative, HER2 negative. The tumor measured 1.3 cm and was grade 2. She was given the clinical stage I. For therapy she received lumpectomy with intraoperative radiation followed by postoperative radiation. She also received Adriamycin, cyclophosphamide and paclitaxel. She had to discontinue paclitaxel early prior to completing therapy secondary to peripheral neuropathy development.

In April of 2019 the patient had missed her screening mammography in 2018. She presented for screening mammography where the noticed an abnormality in her left breast. This is followed by ultrasound which confirmed an approximate 1 cm mass at the 11 o'clock position in her left breast. The patient subsequently received MRI which showed this 7 mm mass in the 11 o'clock position as well as a 4 mm mass in the left breast. The over-read of this MRI at Mayo Clinic confirmed the 7 mm mass in the 11 o'clock position but son no other abnormalities. On 05/06/2019 she underwent ultrasound-guided biopsy which showed invasive ductal carcinoma, grade 3, ER negative, PR negative, HER2 negative. None of the imaging studies showed concern of lymph node involvement. She was given the clinical stage, stage I.

She received neoadjuvant carboplatin and gemcitabine chemotherapy with partial disease response, she did not tolerate paclitaxel. She has had bilateral pulmonary emboli on Xarelto. Genetic testing showed:
Positive Results: Pathogenic PALB2 c.1248del (p.Met416Ilefs*8) variant
Uncertain Results: VUS in POLE c.461G>A (p.Arg154Lys)

She underwent bilateral mastectomy under the care of Dr. Barbara Pockaj on November 15th. She had a residual 12 mm tumor, ypT1c N0, RC B2, 20% cellularity.

Thank you Carmen 602-434-1289    carmengustin@gmail.com
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Apr 19 2021 at 8:12am
Hello and welcome,

Hopefully others that have been on Tecentric (atezolizumab) will see your post and chime in and share their experience. 

Here are a couple of links on Tecentric:



When treating unresectable locally advanced or metastatic triple-negative breast cancer for the first time, adding the immunotherapy medicine Tecentriq (chemical name: atezolizumab) to Taxol (chemical name: paclitaxel) did not improve survival, while adding Tecentriq to Abraxane (chemical name: albumin-bound or nab-paclitaxel) did improve survival, according to results from two studies.

Both studies were presented on Sept. 19, 2020, at the European Society for Medical Oncology (ESMO) Virtual Congress 2020.

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Apr 19 2021 at 7:55pm

The FDA has been reconsidering the use of certain immune checkpoint inhibitors for many diseases, including atezolizumab (Tecentriq) for triple-negative breast cancer. What does that mean for its use in women with breast cancer?

Immunotherapy is very exciting for certain tumor types, but it’s not had the easiest path forward in breast cancer. Breast cancer was [one of] the last tumor histologies to show that it may be beneficial, and the benefits are restricted right now to those tumors that are PD-L1–positive in the metastatic setting. The benefits appear to be fairly restricted to the front-line setting rather than later-line settings. It hasn’t been the blockbuster that it was in other tumor histologies.

The data surrounding atezolizumab from the IMpassion130 trial [NCT02425891] are certainly very promising in terms of progression-free survival and possibly overall survival.2 But it’s restricted to patients with PD-L1–positive tumor immune cells, as tested by [the VENTANA PD-L1 (SP142) assay]. The use of pembrolizumab [Keytruda] in the metastatic setting is restricted to those patients with a CPS [combined positive score] of 10 or greater, which is not the majority of triple-negative breast cancers.

https://www.cancernetwork.com/view/advancing-the-paradigm-of-breast-cancer-therapies-by-critically-gauging-success-across-histologies


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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carmenlynn3 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carmenlynn3 Quote  Post ReplyReply Direct Link To This Post Posted: Apr 20 2021 at 12:28pm
Hi Donna,
thank you so much for your information.

This is a note her appointment from April 9th..  
"I have recommended consideration of Nab paclitaxel +atezolizumab. She does have PDL1 IHC positivity, 1%, on her liver biopsy. We discussed the logistics of this, potentially to start next week. She will need a Port-A-Cath placement as well. We discussed alternatives including capecitabine, and potential later therapy with sacituzumab, and or clinical trials. At this point, her bone lesions are indeterminate, if confirmed, would add denosumab therapy to her regimen.

Do you think her PDLF 1IHC meets the recommendations from your prior email?

And to be sure I'm understanding, based on your first response, I am understanding that based on those studies referenced; the nab-paclitaxel has had success but the paclitaxel has not. And my mom is on the pacilitaxel and not the Nab-pacilitaxel. Just making sure I'm understanding as my mind is not working so great right now Big smile

* they find cancer in her brain yesterday. Radiation to start soon. Dr. make that sound not so serious.
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Apr 20 2021 at 7:00pm
Hi Carmen,

I don't know how they rate positivity for PDL-1.  You may want to ask the doctor if it matters whether you are 1 percent or higher.  From articles I've read, they just talk about PDL1 positive or negative, without showing a percentage(s).

From your first post, I think your mom is getting Abraxane (Protein-bound paclitaxel, also known as nanoparticle albumin–bound paclitaxel or nab-paclitaxel).  There is a really good website that covers chemo drug names, side effects, etc.  If you haven't seen it, you may want to check it out.  It's chemocare.com

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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