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Breast Cancer Case Studies

Case Studies: Recurrent Metastatic ER+ Breast Cancer

Gretchen G. Kimmick, MD, MS, discusses the case of a 52-year-old woman with metastatic ER-positive breast cancer and explains her decisions for sequencing the patient through various lines of therapy following disease progression.

Recurrent Metastatic ER+ Breast Cancer

A 52-Year-Old Woman with Metastatic ER+ Breast Cancer

March 2015

  • A 52-year-old postmenopausal woman was referred for multidisciplinary assessment after being diagnosed with breast cancer, found incidentally on routine screening mammogram
    • Breast MRI revealed a 55-mm lesion in her left breast
    • FH includes a great aunt on her mother’s side who died of breast cancer at age 50
    • gBRCA1/2 negative
  • She underwent lumpectomy with axillary staging
  • Biopsy findings:
    • Histology: invasive ductal carcinoma, grade 3
    • Hormone receptor status: ER+/ PR (-)
    • HER2, IHC 1+
    • OncotypeDx RS-high (27)
  • Staging, T3BN0M0
  • ECOG 1
  • She completed 4 cycles of dose-dense doxorubicin/cyclophosphamide followed by 4 cycles of paclitaxel; she was then started on adjuvant letrozole

April 2017

  • On routine follow-up, chest CT with contrast showed 4 small nodules in the left lung; biopsy confirmed metastatic breast cancer
    • Letrozole was changed to fulvestrant; imaging at 3 months showed progressive disease
    • She was subsequently started on treatment with capecitabine; imaging at 3 and 6 months showed a partial response
    • She was scanned for pulmonary embolism

April 2018

  • On routine follow-up:
    • The patient complained of fatigue and new onset chest pain with deep breathing
    • FDG PET/CT showed 2 new liver lesions and progression in the lung lesions
    • ECOG 1
    • The patient was started on eribulin IV, with a dosing schedule of days 1 and 8, every 21 days
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