Roundtable Roundup: Biomarker-Guided Therapy for HR+ Breast Cancer
In separate, virtual live events, Sarah Sammons, MD, and Ruth O’Regan, MD, discussed molecular profiling and therapeutic options for a patient with advanced breast cancer after multiple lines of therapy.
CASE SUMMARY
- A 52-year-old postmenopausal woman had a history of grade 2, node-negative invasive ductal carcinoma (IDC).
- Estrogen receptor positive (ER+) and progesterone receptor positive (PR+); HER2 immunohistochemistry (IHC) 0; Ki-67 20% of the right breast; 21-gene recurrence score, 27
- Initial therapy included chemotherapy, radiation therapy, and 5 years of adjuvant anastrozole.
- Three years after completing anastrozole, metastatic progression was discovered, including symptomatic bone involvement (multiple vertebrae and bilateral iliac crests).
- Bone marrow aspiration confirmed ER+/PR+, HER2 IHC 0, stage IV IDC.
- ECOG performance status: 1
- Mild anemia
- The patient started letrozole and ribociclib (Kisqali) with denosumab (Xgeva), with good clinical response and marked improvement in her pain.
- She required 1 dose reduction to 400 mg of ribociclib due to neutropenia.
- Twenty months after starting therapy, routine staging scans showed new fluorodeoxyglucose-avid sclerotic and lytic bone lesions.
- She noted mild increase in lower back pain.
- Laboratory studies were normal.
- Circulating tumor DNA (ctDNA) analysis confirmed an ESR1 mutation.
- No evidence of PIK3CA/AKT1/PTEN mutations
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