ONCAlert | 2018 ASCO Annual Meeting
Breast Cancer Case Studies

Adam Brufsky, MD, PhD: Considerations for Different Therapies

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 considerations underlie these choices?

The idea here is that you want to do something that clearly has a proven benefit, number one, and that there are clinical trial data that support it. Number two, you want to do something that allows somebody to maintain a quality of life for as long as possible and is really less cumbersome to the patient.

There is a lot of therapies out there that can be given for a long time. Some of them are chemotherapy, some of them are other therapies, and other hormonal therapies. In general, what I try to do in women with small-volume visceral and/or bone disease that are strongly ER-positive, that have had a response before to hormonal therapy, I really try to maintain them on hormonal agents for as long as possible.

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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