gallifantjack/onc_amie huggingface dataset:
Breast cancer case (naive, Newly diagnosed)
Age: 65
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Very small tumor (T1), no nodes involved
Case description: 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%.
Recommended treatment: Lumpectomy, radiation, endocrine therapy. No need for chemo.
Breast cancer case (naive, Newly diagnosed)
Age: 41
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Very small tumor (T1), no nodes involved
Case description: 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%.
Recommended treatment: Lumpectomy, radiation, endocrine therapy with tamoxifen
Breast cancer case (naive, Newly diagnosed)
Age: 41
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Large tumor (T3), no nodes involved
Case description: 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%.
Recommended treatment: Surgery followed by adjuvant chemotherapy (Taxotere and cyclophosphamide), radiation and then endocrine therapy.
Breast cancer case (naive, Newly diagnosed)
Age: 41
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Large tumor (T3), no nodes involved
Case description: 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%.
Recommended treatment: Surgery followed by radiation and endocrine therapy. No role of chemotherapy here.
Breast cancer case (naive, Newly diagnosed)
Age: 41
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Small tumor (T1), nodal involvement
Case description: 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.
Recommended treatment: Surgery followed by radiation and adjuvant chemotherapy therapy. Then endocrine therapy.
Breast cancer case (naive, Newly diagnosed)
Age: 56
Molecular phenotype: ER+/PR-/HER2-
Special considerations: Small tumor (T1), nodal involvement
Case description: 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.
Recommended treatment: Surgery and chemotherapy, radiation, then endocrine therapy.
Breast cancer case (naive, Newly diagnosed)
Age: 56
Molecular phenotype: ER+/PR-/HER2-
Special considerations: Small tumor (T1), nodal involvement
Case description: 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.
Recommended treatment: Surgery, and endocrine therapy. No chemotherapy.
Breast cancer case (naive, Newly diagnosed)
Age: 56
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Small tumor (T2), nodal involvement, no distant metastasis
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 57
Molecular phenotype: ER+/PR+/HER2+
Special considerations: Very small tumor (T1), no nodes involved, no distant metastasis
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 42
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Inflammatory breast cancer, T4 disease affecting the chest wall, large tumor, N3 disease, bulky nodes, not metastatic
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 35
Molecular phenotype: ER+/PR+/HER2+
Special considerations: Small tumor (T2), no metastatic disease
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 45
Molecular phenotype: ER+/PR+/HER2+
Special considerations: Small tumor (T1), nodal involvement
Case description: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.
Recommended treatment: Treat neoadjuvant chemo with TCHP. Surgical resection, followed by radiation. Then, hormonal therapy and HP in the adjuvant setting if pathological CR achieved.
Breast cancer case (naive, Newly diagnosed)
Age: 50
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Small tumor (T2), very high Ki-67, node negative, no metastasis
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 50
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Very small tumor (T1), very high Ki-67, node negative, no metastasis
Case description: 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
Recommended treatment: 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.)
Breast cancer case (naive, Newly diagnosed)
Age: 59
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Small tumor (T2), nodal involvement, no metastasis
Case description: 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.
Recommended treatment: 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.
Breast cancer case (naive, Newly diagnosed)
Age: 43
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Small tumor (T1), post-surgery, no nodes involved
Case description: 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.
Recommended treatment: Does not qualify for immunotherapy. Radiation after surgery. -Adjuvant chemo with ddAC 4 cycles, followed by weekly taxol or every 3-week Taxotere.
Breast cancer case (naive, Newly diagnosed)
Age: 45
Molecular phenotype: ER+/PR+/HER2+
Special considerations: Small tumor (T1), nodal involvement
Case description: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.
Recommended treatment: Neoadjuvant chemo (TCHP x6), radiation after. Hormonal therapy and HP in adjuvant setting.
Breast cancer case (naive, Newly diagnosed)
Age: 59
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Very small tumor (T1), elected for mastectomy, no nodes involved
Case description: 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.
Recommended treatment: No treatment necessary.
Breast cancer case (naive, Newly diagnosed)
Age: 59
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Very small tumor (T1), no nodes involved, post-mastectomy
Case description: 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.
Recommended treatment: No treatment necessary
Breast cancer case (naive, Newly diagnosed)
Age: 42
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Small tumor (T1), no nodes involved
Case description: 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.
Recommended treatment: Surgery first, then adjuvant chemo (AC -> T)
Breast cancer case (naive, Newly diagnosed)
Age: 65
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Small tumor (T1), no nodal involvement, invasive lobular
Case description: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.
Recommended treatment: Lumpectomy. Radiation. Started on aromatase inhibitors.
Breast cancer case (naive, Newly diagnosed)
Age: 48
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Small tumor (T1), nodal involvement with extra nodal extension
Case description: 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.
Recommended treatment: Taxotere + cyclophosphamide chemotherapy, followed by radiation and endocrine therapy.
Breast cancer case (naive, )
Age: 42
Special considerations: High risk surveillance
Case description: 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.
Recommended treatment: Surveillance every 6 months, alternating ultrasound + mammogram with breast MRI
Breast cancer case (naive, Newly diagnosed)
Age: 91
Molecular phenotype: ER+/PR-/HER2-
Special considerations: Small tumor (T1), Geriatric oncology, no nodal involvement, post lumpectomy
Case description: 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.
Recommended treatment: Complete radiation therapy. Then, exemestane.
Breast cancer case (naive, Newly diagnosed)
Age: 55
Molecular phenotype: ER+/PR-/HER2+
Special considerations: Large tumor (T2), nodal involvement on left side
Case description: 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.
Recommended treatment: Neoadjuvant tx, HP + chemo, and then she had surgery, attained a pathological complete response. Adjuvant HP, radiation and tamoxifen.
Breast cancer case (naive, Newly diagnosed)
Age: 65
Special considerations: Satellite lesions, sentinel lymph nodes with isolated tumor cells
Case description: 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.
Recommended treatment: Radiation followed by endocrine therapy.
Breast cancer case (naive, Newly diagnosed)
Age: 65
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Very small tumor (T1), low Ki-67
Case description: 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%.
Recommended treatment: Upfront surgery. Depending on the pathology report, we will decide on chemotherapy or not.
Breast cancer case (naive, )
Age: 33
Special considerations: High risk surveillance and chemoprevention
Case description: 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.
Recommended treatment: Started on tamoxifen as chemo-prevention.
Breast cancer case (naive, Newly diagnosed)
Age: 55
Special considerations: Small tumor (T1), post lumpectomy, no nodal involvement
Case description: 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.
Recommended treatment: Adjuvant chemotherapy with TC x4.
Breast cancer case (naive, Newly diagnosed)
Age: 39
Molecular phenotype: ER+/PR-/HER2-
Special considerations: Very large tumor (T3) Satellite lesions, R-axillary LAD, residual disease, neoadjuvant therapy, lymph node micrometastasis and extra-nodal extension
Case description: 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.
Recommended treatment: We would do radiation, followed by ovarian suppression plus aromatase inhibitor, plus verzinio and zometa.
Breast cancer case (refractory, Recurrent disease, refractory to multiple lines of treatment)
Age: 61
Molecular phenotype: ER-/PR-/HER2-
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)
Case description: 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?
Recommended treatment: Compassionate care, hospice.
Breast cancer case (refractory, Recurrent disease, refractory to multiple lines of treatment)
Age: 75
Molecular phenotype: ER-/PR-/HER2+
Special considerations: Full course of treatment, multi-organ metastasis, brain radiation, progression in brain after radiation (End of life care)
Case description: 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.
Recommended treatment: Compassionate care, hospice. Alternatively, she can get some benefit from CNS-active therapies such as fam-trastuzumab deruxtecan, or capecitabine/trastuzumab/tucatinib.
Breast cancer case (refractory, Upfront metastatic disease)
Age: 50
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Axillary lymph node involvement, metastasis to bone and liver
Case description: 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.
Recommended treatment: Chemo (Docetaxel-HP per the CLEOPATRA trial) + dual anti-HER2 frontline.
Breast cancer case (refractory, Upfront metastatic disease)
Age: 40
Molecular phenotype: ER-/PR-/HER2-
Special considerations: L-axillary lymph node involvement, metastatic disease to liver, PDL1-positive
Case description: 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?
Recommended treatment: Chemo + immunotherapy.
Breast cancer case (refractory, Upfront metastatic disease)
Age: 40
Molecular phenotype: ER+/HER2+
Special considerations: R-axillary lymph node involvement, high Ki-67, metastatic liver disease
Case description: 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
Recommended treatment: Chemo + dual anti-HER2 frontline
Breast cancer case (refractory, Upfront metastatic disease)
Age: 40
Molecular phenotype: ER+/HER2-
Special considerations: R-axillary lymph node involvement, metastatic liver disease
Case description: 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
Recommended treatment: CDK4/6 + aromatase inhibitor and ovarian suppression.
Breast cancer case (refractory, Upfront metastatic disease)
Age: 85
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 positive
Case description: 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%
Recommended treatment: Single-agent gemcitabine, add Keytruda
Breast cancer case (refractory, Upfront metastatic disease)
Age: 85
Molecular phenotype: ER-/PR-/HER2-
Special considerations: Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 negative
Case description: 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%.
Recommended treatment: Single-agent gemcitabine
Breast cancer case (refractory, Recurrent disease after mastectomy)
Age: 38
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Male breast cancer, post treatment recurrence in mastectomy bed, radiation treatment and recurrence again to the bone
Case description: 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.
Recommended treatment: Endocrine therapy + CDK 4/6 inhibitor.
Breast cancer case (refractory, Post-mastectomy)
Age: 58
Molecular phenotype: ER+/PR+/HER2-
Special considerations: Male breast cancer, obese patient, Small tumor (T2), nodal involvement, post-mastectomy
Case description: 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.
Recommended treatment: Endocrine therapy (Tamoxifen) and radiation. Can also consider adjuvant abemaciclib.
Breast cancer case (refractory, Recurrent disease)
Age: 61
Molecular phenotype: ER+/PR+/HER2+
Special considerations: Previously treated with lumpectomy + radiation, on hormone therapy, spinal and liver metastasis
Case description: 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.
Recommended treatment: Switch to fulvestrant
Breast cancer case (refractory, Progression of disease on therapy)
Age: 65
Molecular phenotype: ER+/PR+/HER2-
Special considerations: On treatment, new lesions noted in liver, ESR-1 mutation
Case description: 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.
Recommended treatment: Change to faslodex and verzinio. Alternatively, test for PIK3CA mutation. Use alpelisib if positive.