Mom (born /37)

11/04 Diagnosed: Er+, Her2+ (1.87 but heterogenous) BC multifocal, Sentinel nodes(2)negative.

Adjuvant tx: Left mastectomy, rads, Arimidex, Fosomax

2007 Parathyroid operation

8/08 Recurrence to liver (diffuse) and lung, borderline her2 biopsy, ER+. bilirubin 3+

9/ /08 1 Taxol infusion, 3 days later severe pain/hospitalization, CT shows liver growth, neutropenic fever days later at nadir, Bili up to 5, begins to drop during hospitalization. Brain CT negative. Hypothesized that impaired liver amplified Taxol dose.

10/ /08 Xeloda, Bili continues to drop, overall improvement

11/ /08 CTC test=0, CT: slight reduction in lung nodule, liver function nearing normal, Brain CT negative

3/17/09 CT: Slight progression lung, Slightly elevated serum Her2 (14 on 12.8 normal scale),

4/1/09 Herceptin monotherapy tri-weekly begins (Loading dose was wrong: i.e. weekly loading dose for 3 week schedule)

5/11/09 serum her2 drops from 14 to 8.5

6/4/09 PET/CT: Slight progression in lung but most liver tumor areas inactive.

6/23/09 CT: 1 of 3 lung nodules slight increase. Navelbine (weekly dose*) added to Herceptin. Serum Her2 up to 14.9

(Continued Herceptin, various disruptions of Navelbine, two rounds of Neupogen due to low wbc, *given bi or tri weekly to allow natural recovery).

9/3/09 Chest CT: lung nodule very slight decrease. (2.9 x 2.5 to 2.7 x 2.5)

10/29/09 PET/CT shows significant lung nodule growth (2.7 x 2.5 to 3.6 x 4cm, SUV max 18.2), significant uptake in both liver lobes. Possible motion artifacts?
Circulating tumor cell(CTC)results=3. Up from 0 a year ago.

11/27/09 CT Chest/ab/pelvis: chest nodule 3.7cm AP x 3.4cm mediolateral, 8x8mm nodule(?) stable 11/27/09 Brain MRI shows no internal brain mets, possible calveolar activity and spot in vertabrae (C4).

Taking daily Tamoxifen and gradually more extensive supplements: boswellia, green tea/capsaicin, milk thistle, feverfew, quercetin combo, High dose vitamin C&D, Whey protein, began curcumin and broccomax mid April

12/6/09 Circulating tumor cell test=0 (down from 3), elevated liver function tests

1/21/10 NM Bone Scan: No sign of bone mets. Some soft tissue uptake via liver mets. Some spinal uptake suggests degenerative disease. Radiologist suggests deference to potentially more sensitive brain MRI.

4/27/10 PET/CT:
Lung nodule from 11/27/09(CT) 3.7 x 3.4 to 3.8 x 3.8, PET SUV Max 18.2 to 19.6. Increased size and uptake of hilar lymph node/adenopathy.
Liver shows significantly decreased activity, from SUV max 14.3 to 5.3
Neck CT shows possible C4 met (3.5 SUV)

5/21/10 Stop Tamoxifen, Start Femara, (16.8 Estradiol level, CTC=0)
6/19/10 Add Tykerb
7/2/10 Add low dose Metformin

Intermittent Issues with lower leg/torso lyphedema begin.

9/2/10 PET/CT: Lung progression 3.8 x 3.8 to 4.1 x 4.4cm, similar uptake(18.1). Possible new lung nodules(same as last?) Liver uptake increased to 8.2. Hypermetabolic free fluid in pelvis. Increased uptake in soft tissue nodule near esophagus (new?). Stable size and uptake of hilar lymph node/adenopathy. C-3 C-4 joint now 4.3 SUV. Multiple colonic diverticula.

TX change: Stop Femara, back to Tamoxifen. Continue Tykerb and Metformin. Add metronomic Capecitabine(3) and Cytoxan (1). Some delay in starting. Intermittent Issues with lower leg/torso lyphedema continue.

2/8/11 PET/CT: Right lower lobe nodule gone. left lower lobe lung mass extended into chest wall (new) but much less uptake. similar size: 4.1 x 4.4cm to 4.4 x 4.0cm. Lymph nodes in chest improved. Mass near esophagus improved, but new area lighting up around it.
Liver not showing uptake!
Stable enlarged left adrenal gland. Stable C4 met.

1 week off Xeloda Tykerb and Cytoxan due to inexplicable rash/hives, resolved by switch to topical olive oil...after antibiotics and prednisone.

6/8/11 PET/CT: Lung mass from 4.1 x 3.4 (or 4.4 x 4.0) to 5.8 x 4.4 cm at maximum axial dimensions. SUV max from 11.6 to 14.7. No mention of extending into chest wall. Relevant to measurement? No other nodules noted.
2 Retroesophogeal lymph nodes insignificant size change, but SUV max from 5.4 to 8.8. Significant or due to more FDG and slightly longer wait before scan??
No uptake in liver!
No uptake in C4 (spine)!
Obviously a difference in behavior between liver and lung.

7/8/11 Tamoxifen switched to Faslodex, increased Metformin

8/5/11 CT: 3.6 x 4.4 (initial large response? Too quick for 4 weeks/loading of Faslodex?)

*Date uncertain dose reductions of Capecitabine (3 to 2), then Cytoxan (daily to every other), due to itchy skin, lowish counts

11/7/11 PET/CT: No uptake in liver, lung 6.0 x 4.9 but SUV @12, lower than previous PET. Similar size to PET/CT but bigger than last CT. Reduced uptake in nodes. No other activity.

1/13/12 Chest CT: Lung mass 6.0 x 5.2, progressive collapse of left lower lobe, small pleural effusion

1/19/12 Monthly Herceptin and Aromasin added

5/3/12 PET/CT: No uptake in liver
Lung mass increase to 8.3 x 7 cm (from 6.0 x 5.2 or 6.0 x 4.9). SUV 13.9 (from 11.5), pleural effusion
Mix of stable/improving (retroesophogeal), more active (subcarinal) nodes

NOTE: Liver ceased uptake after Tamoxifen or Faslodex + metronomic chemo. Perhaps chemo dose reduction (8 or 9/11)too low for lung?

6/1/12 inpatient Chest MRA (limited compared to 1/31 CT): 8.2x7.5 cm, majority does not enhance (cavitation/necrosis), termination of left lower lobe pulmmonary artery, large left pleural effusion

6/3/12 inpatient Chest CT w/o contrast: 6.5x5.9 cm (smaller than 5/3/12 PET/CT, 1/13/12 chest was 6.0x5.2 cm) was done after fluid drain, shows moderate hydropneumothorax)

changed June 4, 2012