2025-10-20
Triple blow, triple clinical challenge
Oncology
By Ana Espino | Published on october 20, 2025 | 3 min read
The synchronous development of several primary cancers is a rare but increasingly observed phenomenon, particularly in patients carrying genetic mutations such as BRCA1. In this particular case, the coexistence of triple-negative breast cancer and rectal adenocarcinoma is all the more complex as it may occur in patients with chronic hepatitis B virus (HBV) infection.
This situation raises major therapeutic challenges. Chemotherapy and immunotherapy, which are essential for aggressive forms such as triple-negative breast cancer, can trigger severe viral reactivation, posing a significant life-threatening risk. A key challenge, therefore, is to:
This study was conducted to document a clinical case combining triple-negative breast cancer, rectal cancer, and HBV reactivation under chemotherapy, and to extract practical lessons to improve multidisciplinary management in oncology.
This case report describes the management of a 55-year-old woman carrying a BRCA1 mutation, diagnosed with triple-negative breast cancer. Neoadjuvant chemotherapy combined with pembrolizumab was initiated, but quickly halted due to severe transaminitis and significant reactivation of hepatitis B virus. Antiviral therapy was then successfully introduced.
Shortly thereafter, a rectal adenocarcinoma was diagnosed. The patient underwent dual curative surgery (mastectomy and rectal resection), followed by adjuvant radiotherapy. Three years later, she remains in complete remission.
This case highlights the importance of HBV screening before any chemotherapy, especially when immunotherapy is planned, and the need to distinguish a second primary cancer from metastatic disease. It also demonstrates the value of coordinated multidisciplinary management in such complex scenarios.
Synchronous cancers, though rare, pose major challenges in oncology, particularly when associated with chronic infections such as hepatitis B. Their management becomes even more complex in the presence of a predisposing genetic mutation such as BRCA1.
The aim of this study was to describe a rare case combining triple-negative breast cancer, rectal adenocarcinoma, and HBV reactivation during chemotherapy, in order to derive practical insights for multidisciplinary management. This case shows that with well-coordinated care, a personalized therapeutic strategy, and careful virological monitoring, a favorable outcome is possible — even in the most complex situations.
Future work will focus on developing integrated clinical algorithms, improving training in viral infection screening within oncology, and individualizing care pathways as part of a precision medicine approach applied to multiple comorbidities.
About the author – Ana Espino
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.
The synchronous development of several primary cancers is a rare but increasingly observed phenomenon, particularly in patients carrying genetic mutations such as BRCA1. In this particular case, the coexistence of triple-negative breast cancer and rectal adenocarcinoma is all the more complex as it may occur in patients with chronic hepatitis B virus (HBV) infection.
This situation raises major therapeutic challenges. Chemotherapy and immunotherapy, which are essential for aggressive forms such as triple-negative breast cancer, can trigger severe viral reactivation, posing a significant life-threatening risk. A key challenge, therefore, is to:
- Distinguish primary cancers from metastatic spread.
- Adapt treatments in a targeted manner, taking into account existing comorbidities to avoid any worsening of the patient’s condition.
- Ensure rigorous multidisciplinary coordination.
This study was conducted to document a clinical case combining triple-negative breast cancer, rectal cancer, and HBV reactivation under chemotherapy, and to extract practical lessons to improve multidisciplinary management in oncology.
Can everything be treated… without making everything worse?
This case report describes the management of a 55-year-old woman carrying a BRCA1 mutation, diagnosed with triple-negative breast cancer. Neoadjuvant chemotherapy combined with pembrolizumab was initiated, but quickly halted due to severe transaminitis and significant reactivation of hepatitis B virus. Antiviral therapy was then successfully introduced.
Shortly thereafter, a rectal adenocarcinoma was diagnosed. The patient underwent dual curative surgery (mastectomy and rectal resection), followed by adjuvant radiotherapy. Three years later, she remains in complete remission.
This case highlights the importance of HBV screening before any chemotherapy, especially when immunotherapy is planned, and the need to distinguish a second primary cancer from metastatic disease. It also demonstrates the value of coordinated multidisciplinary management in such complex scenarios.
Coordinate to survive better
Synchronous cancers, though rare, pose major challenges in oncology, particularly when associated with chronic infections such as hepatitis B. Their management becomes even more complex in the presence of a predisposing genetic mutation such as BRCA1.
The aim of this study was to describe a rare case combining triple-negative breast cancer, rectal adenocarcinoma, and HBV reactivation during chemotherapy, in order to derive practical insights for multidisciplinary management. This case shows that with well-coordinated care, a personalized therapeutic strategy, and careful virological monitoring, a favorable outcome is possible — even in the most complex situations.
Future work will focus on developing integrated clinical algorithms, improving training in viral infection screening within oncology, and individualizing care pathways as part of a precision medicine approach applied to multiple comorbidities.
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About the author – Ana Espino
PhD in Immunology, specialized in Virology
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