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Triple positive locally advanced breast cancer is not a single disease entity. Chemosensitivity varies among them and the prognosis is determined by the level of response. Unfortunately, this patient is showing a chemo resistant variant and she will need adequate loco-Regional therapy “surgery and radiation therapy”. The decreased number of lymph nodes removed may reflect a chemotherapy effect. Radiological assessment of the Axilla is necessary to rule out residual disease. Further surgery for residual disease in the Axilla will not affect overall survival but may prevent brachioplexaopathy but at the risk of lymphoedema.
Compared with HER2 positive and TNBC BCa, Tripple positive BCa is relatively insensitive to Chemotherapy.
In this case, we need more detailed information about the pre-NAC evaluation of the primary tumor and axillary LN. Besides, the detailed information about the specific surgery on axillary, ALND or SLNB?
For adjuvant setting, adjuvant radiation and endocrine therapy should also be included.
İn our recent study, included 570 diagnosed with breast cancer patient and 77 (13.5%) cases of them identified in biological subtypes Triple Positive.
İn 51(66%) of these patients, stage III-IV has been detected.
Treatment of 4AC + Herceptin + Taxane and 13-times Herceptin according to NCCN protocol have not always been effectiv.
In some patients progression of the disease was determined on the during treatment or shortly after treatment.
Pharmacogenetic tests in these patients revealed hyper-expression of TUBB-3 and mutations from PIK3CA.
Therefore, it is advisable to examine TUBB3, PIK3CA, ERCC1, RRM1, TYMS, ABCB1 prior to treatment in these patients. Standard treatment protocols can be changed depending on the outcome.
The proposed patient should be treated with anti-HER2 therapy in combination with adjuvant radiation.
If progress continues, with TDM1 can be treated.
Lapatinib or Neratinib is recommended for line III anti-HER2 therapy.
Pending Moderator approval.
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