Roundtable Roundup: ER+/PR+, HER2– Breast Cancer

Ruta D. Rao, MD, and Virginia G. Kaklamani, MD, discuss with participants the case of a patient with breast cancer who has received multiple lines of therapy and what the next steps are for her treatment.

CASE SUMMARY

Initial presentation:

A 56-year-old, postmenopausal woman presented with a palpable right breast mass with no clinically abnormal axillary lymph nodes.
Core biopsy: grade II invasive ductal carcinoma (IDC), estrogen receptor positive (ER+)/progesterone receptor positive (PR+), HER2 immunohistochemistry (IHC) score of 0, Ki-67 33%
Lumpectomy and sentinel lymph node (SLN) biopsy: 3.0 cm, grade 2 IDC, 2 SLN negative for malignant cells
21-gene recurrence score: 27
She received 4 cycles of docetaxel and cyclophosphamide followed by radiation therapy and completed 5 years of adjuvant aromatase inhibitor (AI).

Three years later:

The patient reported right-sided abdominal pain and mild nausea.
CT scan of the chest/abdomen/pelvis showed 3 suspicious liver lesions (right lobe, largest 2 cm).
Liver biopsy showed adenocarcinoma consistent with breast primary.
- ER+/PR+, HER2 IHC 0
Liver function test: within normal limits.
Comprehensive molecular testing from tissue biopsy showed no actionable alterations.
AI plus palbociclib (Ibrance) was initiated. Response: Therapy tolerated well with grade 2 neutropenia that did not require dose modification of palbociclib.

Twenty months later:

Follow-up imaging showed increased size of both liver nodules and 2 new lung nodules, the largest measuring 0.9 cm.
Her ECOG performance status was 0 and her liver enzymes were normal.