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Breast Cancer Case Studies

Adam Brufsky, MD, PhD: Expectations 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 the expectations of therapy in this setting?

The therapy choice that I would make is exemestane and everolimus, and I think that when compared to the standard of care which existed before everolimus, exemestane alone had about a 4-month progression-free survival. When exemestane and everolimus were given together, that progression free survival went up to about 9 months. In fact, if you look at some of the data from the clinical trials, the independently reviewed data, it's probably about 10 months.

Clearly this is something that can double the progression free survival, and what's interesting to me is not only the progression free survival, but survival after 1 and 2 years. With 1 year and 2 year survival, there's a tail to those curves. So there are a certain percentage of women, probably about 15% or 20%, that are going to be long-term non-progressors and can be maintained on this therapy for years, potentially.

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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