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Breast Cancer Case Studies

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

Of the many choices that we have, one of the choices that I really like is a combination of an anti-hormonal agent and a targeted therapy, and we have a lot of really good data for exemestane and everolimus in this setting. I think that the expectation is that there will be at least a fairly substantial benefit in progression-free survival, almost doubling from about 4 months, which is the standard in this setting, to about 9 to 10 months when exemestane and everolimus are given.

Again, that's my expectation here. My expectation is that there is also a kind of tail to the survival curve, to the non-progression curve, of these women. Ten to 15%, maybe even 20% of these women will be non-progressers within a year and potentially even longer. You have a group of women that will respond long-term to these therapies.

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
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