Adam Brufsky, MD, PhD: Considerations for Different Therapies

What considerations underlie these choices?

The idea here is that you want to do something that clearly has a proven benefit, number one, and that there are clinical trial data that support it. Number two, you want to do something that allows somebody to maintain a quality of life for as long as possible and is really less cumbersome to the patient.

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