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Breast Cancer Case Studies

Case Studies: Recurrent HR+ Breast Cancer

Joyce O’Shaughnessy, MD, reviews the case of a 58-year-old with recurrent HR+ breast cancer and explores possible treatment options including the sea-change frontline therapy justified by the MONALEESA-3 and PALOMA 3 trials, CDK4/6 inhibitor with fulvestrant.

Recurrent HR+ Breast Cancer

A 58-Year-Old Woman With Recurrent HR+ Breast Cancer

December 2013

  • A 58-year-old postmenopausal woman was referred for further evaluation of a suspicious left-sided lesion found incidentally on routine mammogram
    • MRI revealed a 4.3-cm lesion in her left breast
    • PMH unremarkable
  • She underwent lumpectomy with axillary staging
  • Biopsy findings:
    • Histology: lobular carcinoma, grade 2
    • Hormone receptor status: ER+/ PR (-)
    • HER2, IHC 1+
    • OncotypeDx RS, 19
  • Staging, T2N0M0
  • ECOG 0
  • She was started on adjuvant anastrozole

September 2018

  • On routine follow-up, the patient reports increasing fatigue and intermittent bouts of abdominal pain with nausea
  • CT with contrast showed several small lesions in the liver; biopsy confirmed metastatic disease.
    • The patient was started on ribociclib; anastrozole was changed to fulvestrant
    • Imaging at 3 and 6 months showed a partial response
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