The Community Resource in Targeted Therapies
Driving Knowledge. Empowering Change. Optimizing Outcomes.
ONCAlert | Upfront Therapy for mRCC
Breast Cancer Case Studies

Adam Brufsky, MD, PhD: Considerations for Different Therapies in Breast Cancer

Adam Brufsky, MD, PhD
Published Online:Apr 25, 2016
Mary is a 62-year old woman who in mid-2014 complained of rib pain. Rib plain films revealed a lytic lesion of the left 5th rib. Bone scan revealed multiple areas of uptake in the lumbosacral spine and ribs.

ER+/HER2-Breast Cancer with Adam Brufsky, MD, PhD and Kimberly Blackwell, MD: Case 2



What considerations underlie these choices?

The things that I look at when I try to decide what kind of therapy a woman should recieve for metastatic breast cancer, particularly a breast cancer that's ER-positive, is that I want something that the lady can be on long-term and she could potentially be on for years. A lot of these patients really do not progress for a number of years, and you really want to do something that they have no problem taking, they can take for a long time potentially, that has minimal side effects compared to the other agents, and really has efficacy obviously. So something that can maintain their quality of life for a long time.

ER+/HER2-Breast Cancer: Case 2

Mary is a 62-year-old woman, who in mid-2014 complained of rib pain. Rib plain films revealed a lytic lesion of the left 5th rib. Bone scan revealed multiple areas of uptake in the lumbosacral spine and ribs.

  • PET-CT revealed lytic lesions in the lumbosacral spine and ribs, and a 3 cm right upper lobe lesion in the lung with a PET SUV value of 6, indicating malignancy
  • A mammogram and ultrasound of the left breast revealed a 2 cm speculated mass in the upper outer quadrant of the left breast
  • Core needle biopsy of this lesion revealed infiltrating ductal carcinoma, ER 80%, Her2 negative
  • She was placed on denosumab 120 mg SQ monthly, and anastrozole 1 mg orally daily. Her pain resolved within 1 month, and on follow-up CT at 4 months her bone lesions appeared sclerotic and her lung lesion had reduced to 2 cm. Her anastrozole and denosumab were continued

In mid-2015 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 lung lesion to 4 cm.

  • She was placed on fulvestrant 500 mg IM monthly and denosumab was continued. Within 2 months her pain improved, and a repeat CT of the chest in late 2015 demonstrated reduction of the lung lesion to 2 cm
  • In March 2016 she complained of new right scapular pain. A PET-CT revealed new lytic lesions of the left scapula and right ribs, and a new lung nodule in the left upper lobe 1 cm in diameter with an increase in the right upper lobe lesion to 3 cm
Publications
Copyright © TargetedOnc 2018 Intellisphere, LLC. All Rights Reserved.