Case Impressions: A 67-Year-Old With HR+ Breast Cancer

Video

Kevin Kalinsky, MD, MS, presents a case of ER-positive/PR-positive breast cancer and highlights the prevalence of cases such as this in the United States.

Kevin Kalinsky, MD, MS: This is a 67-year-old patient who is postmenopausal, and who palpates a new lump in her left breast. She has no family history. Has only hypertension that’s well controlled on medication.

So, as part of her workup, she undergoes breast imaging which identifies a 4.4 centimeter solid tumor in her breast. No suspicious adenopathy.

So she undergoes a core biopsy that is positive for invasive ductal carcinoma that is strongly estrogen receptor-positive at 100% and progesterone receptor is 40%. It’s HER2 negative by protein expression and there’s a Ki67 of 30%. It’s grade 3. So she undergoes a lumpectomy and has a sentinel lymph node biopsy.

It’s a T2, N1 MX lesion. It’s around 4 centimeters, 2 out of 5 lymph nodes are involved. She undergoes testing with the 21-gene recurrence assay, which is 30 and her performance is excellent. So she does not have any residual disease.

She starts her adjuvant chemotherapy with docetaxel [Taxotere] and cyclophosphamide. She completes radiation therapy to the intact breast, and then she goes on to receive an aromatase inhibitor, 2 years of abemaciclib with the plan of continuing the aromatase inhibitor after.

So this is a common occurrence. Hormone receptor-positive, protein-negative breast cancer is the most common type of breast cancer that we see. Patients can either palpate that lesion or they may just undergo screening imaging and it can be detected.

We’re seeing during the pandemic that rates of mammography, screening mammography, has decreased. So it’s not infrequent that we’re seeing more patients come in with palpable breast lesions.

And risk factors can vary but could include long-term exposure to hormone replacement therapy, family history, that’s important. We know that approximately 1 in 8 women can develop breast cancer in their lifetime, but those patients who have a high family risk may be at higher risk.

And we certainly utilize hereditary genetics to determine whether somebody, especially if they have a high family history or other red flags, like they’re premenopausal at the time of diagnosis, may have a familial predisposition for the development of breast cancer.

Transcript edited for clarity.

Case: A 67-Year-Old Woman with ER+/PR+ Breast Cancer

Initial Presentation

  • A 67-year-old, postmenopausal woman presents with a newly diagnosed lump in her left breast
  • She has 2 grown children, no family history of cancer, and underwent menopause at age 48
  • PMH is significant for hypertension that is well controlled with medication

Clinical work-up

  • Imaging demonstrated a 4.4-cm solid mass in the right upper quadrant with no suspicious adenopathy
  • Core biopsy: positive for invasive ductal carcinoma, ER 100%/PR 40%; HER2 IHC 1+; Ki-67 30%; modified Bloom-Richardson grade 3
  • Lumpectomy and sentinel lymph node biopsy performed
  • Tumor size is 4.5 cm, and 2/5 LNs are positive for metastatic disease
  • 21-gene recurrence assay score is 30
  • T2N1M0, stage IIA
  • ECOG PS is 0

Treatment

  • Patient underwent partial mastectomy with no residual disease
  • She is started on adjuvant chemotherapy with cyclophosphamide and docetaxel
  • She is given radiation therapy to intact breast
  • Followed by aromatase inhibitor + 2 years of abemaciclib
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