gallifantjack/demo_onc_amie huggingface dataset:
Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Progression of disease on therapy
Special considerations: On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung
Recommended management: Change to elacestrant. Continue xgeva for bone disease.
Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Progression after mastectomy and radiation
Special considerations: Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features
Recommended management: Change to enhertu and xgeva, continue anastrazole
Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Progression of disease on therapy
Special considerations: Upfront metastasis with bone involvement, progressed on therapy, now with PIK3CA mutation
Recommended management: Change to Alpelisib and Fulvestrant. Continue Xgeva for bone disease
Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Recurrence of disease
Special considerations: Finished treatment, no residual disease, new recurrence in brain
Recommended management: Radiation for brain metastasis and Enhertu for systemic therapy
Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Recurrence of disease
Special considerations: Finished treatment with KEYNOTE-522 protocol, recurrence at mastectomy scar, no other sites of disease, recurrence is triple negative as well
Recommended management: Refer for surgical resection per CALOR
Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Progression of disease
Special considerations: Treated with KEYNOTE-522, residual disease, got Xeloda, progression to liver and then bone
Recommended management: Change to Sacituzumab-govitecan vs Enhertu
Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Progression of disease
Special considerations: Treated appropriately, bone metastasis, on Enhertu, had brain metastasis, continued progression of disease on treatment, brain biopsy showing HER2+ disease
Recommended management: Change to tucatinib, trastuzumab and xeloda