Clinical Scenario: A 65-Year-Old Post-Menopausal Woman With Metastatic Breast Cancer
Oncologists present the clinical scenario of a 65-year-old woman with recurrent HR-positive, HER2-low breast cancer, and discuss optimal sequencing of systemic therapies in this setting.
EP: 1.Clinical Scenario: A 57-Year-Old Woman With Metastatic Breast Cancer
EP: 2.Current First-Line Systemic Therapy Options for HER2+ Metastatic Breast Cancer
EP: 3.Key Clinical Trials in the First-Line Treatment of HER2+ Metastatic Breast Cancer
EP: 4.Standard of Care Regimens for Second-Line Treatment of HER2+ Metastatic Breast Cancer
EP: 5.Sequencing Therapies in the Third-Line and Beyond for Patients With HER2+ Metastatic Breast Cancer
EP: 6.Clinical Scenario: A 65-Year-Old Post-Menopausal Woman With Metastatic Breast Cancer
EP: 7.Approaches to Mutation Testing for Patients With HR+/HER2-low mBC and ET-Resistant Disease
EP: 8.Factors for Consideration When Choosing Among Options for Patients with ET-resistant ER+/HER2- mBC
EP: 9.Sequencing Antibody-Drug Conjugates (ADCs) in HR+/HER2-Low Metastatic Breast Cancer
EP: 10.Exciting Data in the Treatment of HER2-low from SABCS 2023
The discussion shifts to a new case of a 65-year-old postmenopausal woman with a history of stage 1 hormone receptor-positive, HER2-negative breast cancer diagnosed 6 years ago and treated with 5 years of adjuvant aromatase inhibitor therapy.
She now presents with chest pain and shortness of breath. Workup reveals a solitary lesion in the right lung, biopsy-confirmed as recurrent breast cancer that is strongly hormone receptor-positive and HER2-negative (IHC 1+, non-amplified on FISH). NGS testing was negative for actionable mutations. She was started on first-line aromatase inhibitor therapy.
After 18 months, scans show progression in the lung. Liquid biopsy did not detect ESR1 or PIK3CA mutations. She is now discussing next treatment options with her oncologist.
Spring asks Bhave if this patient's case is representative of metastatic HR+/HER2-low patients seen in practice. Bhave agrees it is a common scenario, though a bit unusual for the initial stage 1 diagnosis to recur metastatically, as that risk is typically <10%.
Bhave is glad comprehensive genomic profiling was done upfront on the metastatic biopsy, as tissue is more sensitive for detecting mutations like PIK3CA compared to liquid biopsy alone. Her approach aligns with using an aromatase inhibitor first-line unless there was a rapid adjuvant relapse, then pursuing plasma genomics at progression to guide therapy selection.
Overall, this case highlights real-world evaluation and first-line management of HR+/HER2-low metastatic breast cancer, in line with current standards incorporating genomic profiling.
This summary was AI-generated and edited for clarity.
