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Breast Cancer Case Studies

Adam Brufsky, MD, PhD: Choices of Therapy

Adam Brufsky, MD, PhD
Published Online:Apr 20, 2016
Angela is a 56-year-old woman, who in 2013 was diagnosed with a 4 cm IDC of the left breast, ER positive at 50%, PR negative, and HER2 negative.

ER+/HER2-Breast Cancer with Adam Brufsky, MD, PhD and Kimberly Blackwell, MD: Case 1

What are your choices of therapy?

This is a lady who presented with small volume liver metastases, and in her case she was on adjuvant anastrozole when she relapsed. For her bone metastases we gave her denosumab and then changed it to another hormonal therapy fulvestrant. Now she has progression in both bone and liver, but it's minimal – it's not a lot. The real question here is what to do, and we have a lot of options, but in this case I think I would give exemestane and everolimus.

The reason for that is I would like to do some therapy for this lady in which she can maintain her quality of life for as long as possible. It's kind of what we want to do here. There are many different options that we'll talk about in a few minutes, but by and large for somebody who has asymptomatic disease, I really try to stick with hormonal therapy and/or targeted therapy for as long as I can.

ER+/HER2-Breast Cancer: Case 1

Angela is a 56-year-old woman, who in 2013 was diagnosed with a 4 cm IDC of the left breast, ER positive at 50%, PR negative, and Her2 negative. She was treated with four cycles of neoadjuvant doxorubicin and cyclophosphamide, followed by twelve weeks of paclitaxel.

  • She then had a left MRM with AD, showing a residual 1.5 cm tumor with 3/10 LN positive
  • She received anastrozole, and in early 2015 she complained of low back pain and a bone scan revealed multiple areas of uptake in the lumbosacral spine
  • PET-CT revealed lytic lesions in the lumbosacral spine and pelvis, and a 2 cm low attenuation lesion in the liver with a PET SUV value of 10, indicating malignancy

She was placed on denosumab 120 mg SQ monthly, and fulvestrant 500 mg IM monthly. Her pain resolved within 2 months, and on follow-up CT qt 4 months her bone lesions appeared sclerotic and her liver lesion had reduced to 1 cm. Her fulvestrant and denosumab were continued.

  • In early 2016 she again complained of worsening low back pain and left hip pain
  • Repeat PET-CT demonstrated new lytic lesions in the left iliac crest as well as an enlargement of the liver lesion to 3 cm
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