gallifantjack/onc_amie huggingface dataset:
Breast cancer case (refractory, Progression of disease on therapy)
Age: 59
Molecular phenotype: ER+/PR+/HER2-
Special considerations: On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung
Case description: 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.
Recommended treatment: Continue faslodex + Everolimus or Enhertu
Breast cancer case (refractory, Progression of disease on therapy)
Age: 63
Molecular phenotype: ER+/PR+/HER2-
Special considerations: On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung
Case description: 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.
Recommended treatment: Change to elacestrant. Continue xgeva for bone disease.
Breast cancer case (refractory, Progression after mastectomy and radiation)
Age: 55
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features
Case description: 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.
Recommended treatment: Change to enhertu and xgeva, continue anastrazole
Breast cancer case (refractory, Progression of disease on therapy)
Age: 63
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Upfront metastasis with bone involvement, progressed on therapy, now with PIK3CA mutation
Case description: 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.
Recommended treatment: Change to Alpelisib and Fulvestrant. Continue Xgeva for bone disease
Breast cancer case (refractory, Recurrence of disease)
Age: 49
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Finished treatment, no residual disease, new recurrence in brain
Case description: 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.
Recommended treatment: Radiation for brain metastasis and Enhertu for systemic therapy
Breast cancer case (refractory, Recurrence of disease)
Age: 45
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Finished treatment with KEYNOTE-522 protocol, recurrence at mastectomy scar, no other sites of disease, recurrence is triple negative as well
Case description: 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.
Recommended treatment: Refer for surgical resection per CALOR
Breast cancer case (refractory, Progression of disease)
Age: 53
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Treated with KEYNOTE-522, residual disease, got Xeloda, progression to liver and then bone
Case description: 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.
Recommended treatment: Change to Sacituzumab-govitecan vs Enhertu
Breast cancer case (refractory, Progression of disease)
Age: 57
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Treated appropriately, bone metastasis, on Enhertu, had brain metastasis, continued progression of disease on treatment, brain biopsy showing HER2+ disease
Case description: 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.
Recommended treatment: Change to tucatinib, trastuzumab and xeloda