gallifantjack/demo_onc_amie huggingface dataset:
Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), no nodes involved
Recommended management: Lumpectomy, radiation, endocrine therapy. No need for chemo.
Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), no nodes involved
Recommended management: Lumpectomy, radiation, endocrine therapy with tamoxifen
Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Large tumor (T3), no nodes involved
Recommended management: Surgery followed by adjuvant chemotherapy (Taxotere and cyclophosphamide), radiation and then endocrine therapy.
Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Large tumor (T3), no nodes involved
Recommended management: Surgery followed by radiation and endocrine therapy. No role of chemotherapy here.
Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement
Recommended management: Surgery followed by radiation and adjuvant chemotherapy therapy. Then endocrine therapy.
Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.
Case type: naive
Molecular phenotype: ER+/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement
Recommended management: Surgery and chemotherapy, radiation, then endocrine therapy.
Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.
Case type: naive
Molecular phenotype: ER+/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement
Recommended management: Surgery, and endocrine therapy. No chemotherapy.
Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.
Case type: naive
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Newly diagnosed
Special considerations: Small tumor (T2), nodal involvement, no distant metastasis
Recommended management: Neoadjuvant chemotherapy. TCHP 6 cycles. Surgery, radiation, targeted therapy with HP if she had PR, or TDM1 if had residual disease at time of surgery.
Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.
Case type: naive
Molecular phenotype: ER+/PR+/HER2+
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), no nodes involved, no distant metastasis
Recommended management: Surgery first. Confirm disease. Neoadjuvant is only done for 2cm or greater tumors. Adjuvant taxol + Herceptin for 12 weeks, and Herceptin to continue for 9 more months per APT trial. Endocrine therapy as well.
Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.
Case type: naive
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Newly diagnosed
Special considerations: Inflammatory breast cancer, T4 disease affecting the chest wall, large tumor, N3 disease, bulky nodes, not metastatic
Recommended management: Chemotherapy – TCHP for 6 cycles. If responds well, modified radical mastectomy with axillary lymph node dissection and removal of all the skin. Go for radiation and then adjuvant therapy which can either be HP or T-DM1 depending on residual disease.
Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.
Case type: naive
Molecular phenotype: ER+/PR+/HER2+
Treatment status: Newly diagnosed
Special considerations: Small tumor (T2), no metastatic disease
Recommended management: TCH for 6 cycles. No pertuzumab because no lymph node disease or T3 tumor. Surgery. Adjuvant targeted therapy would be TDM1 or Herceptin. Then, she will get endocrine therapy.
Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.
Case type: naive
Molecular phenotype: ER+/PR+/HER2+
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement
Recommended management: Treat neoadjuvant chemo with TCHP. Surgical resection, followed by radiation. Then, hormonal therapy and HP in the adjuvant setting if pathological CR achieved.
Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T2), very high Ki-67, node negative, no metastasis
Recommended management: KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together.
Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), very high Ki-67, node negative, no metastasis
Recommended management: Surgery first. No role for neoadjuvant if < 2 cm. If truly has 7 mm on surgery, give TC chemo for 4 cycles. (Clinical trial data would support adjuvant AC -> T, per the ABC trial.)
Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T2), nodal involvement, no metastasis
Recommended management: KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together.
Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), post-surgery, no nodes involved
Recommended management: Does not qualify for immunotherapy. Radiation after surgery. -Adjuvant chemo with ddAC 4 cycles, followed by weekly taxol or every 3-week Taxotere.
Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.
Case type: naive
Molecular phenotype: ER+/PR+/HER2+
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement
Recommended management: Neoadjuvant chemo (TCHP x6), radiation after. Hormonal therapy and HP in adjuvant setting.
Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.
Case type: naive
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), elected for mastectomy, no nodes involved
Recommended management: No treatment necessary.
Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), no nodes involved, post-mastectomy
Recommended management: No treatment necessary
Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), no nodes involved
Recommended management: Surgery first, then adjuvant chemo (AC -> T)
Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), no nodal involvement, invasive lobular
Recommended management: Lumpectomy. Radiation. Started on aromatase inhibitors.
Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.
Case type: naive
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), nodal involvement with extra nodal extension
Recommended management: Taxotere + cyclophosphamide chemotherapy, followed by radiation and endocrine therapy.
Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.
Case type: naive
Special considerations: High risk surveillance
Recommended management: Surveillance every 6 months, alternating ultrasound + mammogram with breast MRI
Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.
Case type: naive
Molecular phenotype: ER+/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), Geriatric oncology, no nodal involvement, post lumpectomy
Recommended management: Complete radiation therapy. Then, exemestane.
Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.
Case type: naive
Molecular phenotype: ER+/PR-/HER2+
Treatment status: Newly diagnosed
Special considerations: Large tumor (T2), nodal involvement on left side
Recommended management: Neoadjuvant tx, HP + chemo, and then she had surgery, attained a pathological complete response. Adjuvant HP, radiation and tamoxifen.
Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.
Case type: naive
Treatment status: Newly diagnosed
Special considerations: Satellite lesions, sentinel lymph nodes with isolated tumor cells
Recommended management: Radiation followed by endocrine therapy.
Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.
Case type: naive
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Very small tumor (T1), low Ki-67
Recommended management: Upfront surgery. Depending on the pathology report, we will decide on chemotherapy or not.
Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.
Case type: naive
Special considerations: High risk surveillance and chemoprevention
Recommended management: Started on tamoxifen as chemo-prevention.
Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.
Case type: naive
Treatment status: Newly diagnosed
Special considerations: Small tumor (T1), post lumpectomy, no nodal involvement
Recommended management: Adjuvant chemotherapy with TC x4.
Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.
Case type: naive
Molecular phenotype: ER+/PR-/HER2-
Treatment status: Newly diagnosed
Special considerations: Very large tumor (T3) Satellite lesions, R-axillary LAD, residual disease, neoadjuvant therapy, lymph node micrometastasis and extra-nodal extension
Recommended management: We would do radiation, followed by ovarian suppression plus aromatase inhibitor, plus verzinio and zometa.
Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Recurrent disease, refractory to multiple lines of treatment
Special considerations: KEYNOTE-522 trial, residual disease, metastasis to the bone, multiple lines of treatment, declining performance status, further disease progression (End of life care)
Recommended management: Compassionate care, hospice.
Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2+
Treatment status: Recurrent disease, refractory to multiple lines of treatment
Special considerations: Full course of treatment, multi-organ metastasis, brain radiation, progression in brain after radiation (End of life care)
Recommended management: Compassionate care, hospice. Alternatively, she can get some benefit from CNS-active therapies such as fam-trastuzumab deruxtecan, or capecitabine/trastuzumab/tucatinib.
Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Upfront metastatic disease
Special considerations: Axillary lymph node involvement, metastasis to bone and liver
Recommended management: Chemo (Docetaxel-HP per the CLEOPATRA trial) + dual anti-HER2 frontline.
Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Upfront metastatic disease
Special considerations: L-axillary lymph node involvement, metastatic disease to liver, PDL1-positive
Recommended management: Chemo + immunotherapy.
Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver
Case type: refractory
Molecular phenotype: ER+/HER2+
Treatment status: Upfront metastatic disease
Special considerations: R-axillary lymph node involvement, high Ki-67, metastatic liver disease
Recommended management: Chemo + dual anti-HER2 frontline
Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver
Case type: refractory
Molecular phenotype: ER+/HER2-
Treatment status: Upfront metastatic disease
Special considerations: R-axillary lymph node involvement, metastatic liver disease
Recommended management: CDK4/6 + aromatase inhibitor and ovarian suppression.
Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Upfront metastatic disease
Special considerations: Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 positive
Recommended management: Single-agent gemcitabine, add Keytruda
Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.
Case type: refractory
Molecular phenotype: ER-/PR-/HER2-
Treatment status: Upfront metastatic disease
Special considerations: Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 negative
Recommended management: Single-agent gemcitabine
Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Recurrent disease after mastectomy
Special considerations: Male breast cancer, post treatment recurrence in mastectomy bed, radiation treatment and recurrence again to the bone
Recommended management: Endocrine therapy + CDK 4/6 inhibitor.
Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Post-mastectomy
Special considerations: Male breast cancer, obese patient, Small tumor (T2), nodal involvement, post-mastectomy
Recommended management: Endocrine therapy (Tamoxifen) and radiation. Can also consider adjuvant abemaciclib.
Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2+
Treatment status: Recurrent disease
Special considerations: Previously treated with lumpectomy + radiation, on hormone therapy, spinal and liver metastasis
Recommended management: Switch to fulvestrant
Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Progression of disease on therapy
Special considerations: On treatment, new lesions noted in liver, ESR-1 mutation
Recommended management: Change to faslodex and verzinio. Alternatively, test for PIK3CA mutation. Use alpelisib if positive.
Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.
Case type: refractory
Molecular phenotype: ER+/PR+/HER2-
Treatment status: Progression of disease on therapy
Special considerations: On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung
Recommended management: Continue faslodex + Everolimus or Enhertu