HR+ Breast Cancer Prognosis

Joyce O’Shaughnessy, MD:This patient is 62 years old and she noted a rapidly enlarging mass in her breast. When she went to her physician, she had a 6 cm mass in her breast and she had axillary adenopathy as well. And the biopsy showed grade 3 invasive ductal breast cancer that was strongly estrogen receptor-positive, progesterone receptor-negative, and HER2 [human epidermal growth factor receptor 2]-negative. Unfortunately, on staging evaluation, she had multiple liver metastasis at the time of presentation, no other sites of metastasis. And her liver function tests were mildly elevated. Her transaminases were mildly elevated. Bilirubin and alkaline phosphatase were normal, CBC [complete blood count] normal. Otherwise, a fairly healthy woman, no serious comorbidities. So she’s presenting with de novo metastatic disease, a grade 3 aggressive breast cancer, rapidly enlarging, already metastatic to the liver at the time of presentation.

When women present with de novo metastatic disease that’s estrogen receptor-positive, progesterone receptor-negative, HER2-negative, and grade 3 with liver metastasis at presentation, the median overall survival would probably be in the 2 to 3 year range. It’s quite variable, and it really does depend on the overall tempo of the disease. This woman’s tempo, unfortunately, was a rapidly growing mass and already multiple liver metastasis at the time of presentation. Things are changing for the better with regard to our therapies. But generally speaking, the median overall survival is probably in the range of 2 to 3 years for this woman.

Transcript edited for clarity.

Case: A 62-Year-Old Woman WithDe NovoInvasive Ductal Carcinoma

• A 62-year-old woman presented to her gynecologist with a large mass in her right breast
• Breast MRI confirmed the presence of a 6-cm mass and axillary adenopathy
• Labs: ALT 95, AST 70 (elevated)
• Core needle biopsy confirmed ER+ PR (-) HER2(-) carcinoma, grade 3
• CT chest, abdomen, and pelvis showed widely scattered liver metastases