7:00 PM-8:00 PM
Cases from Drs Allison, Astrow and Moss
8:00 PM-8:15 PM
Cases from the audience
8:15 PM-9:15 PM
Cases from Drs Allison, Astrow and Moss
Mary Ann K Allison, MD
Case 1:
A 31-year-old woman who is 27 weeks pregnant is diagnosed with a 4-cm, triple-negative, invasive breast adenocarcinoma. The patient prefers breast conservation, but her surgeon states that this would require tumor shrinkage.
Discussion Issue:
Should neoadjuvant chemotherapy be recommended? If so, which regimen?
Case 2:
In 2005, this 58-year-old woman presented with ER-negative, PR-positive, HER2-positive breast cancer and extensive metastatic disease to the liver. She was enrolled on the TORI B-03 trial and received trastuzumab and bevacizumab for one year with improvement in the breast lesion and liver metastases and another year with stable disease. She then received trastuzumab and an aromatase inhibitor for seven months, during which time the primary tumor was resected. She then developed progressive liver metastases.
Discussion Issue:
Which systemic therapy would you recommend at this point?
Case 3:
A 44-year-old premenopausal woman is diagnosed with ER-positive, HER2-positive, node-positive (1/12) breast cancer. Because the tumor is BRCA2-positive, the patient undergoes bilateral mastectomies and oophorectomies.
Discussion Issues:
Should further endocrine intervention be recommended (tamoxifen or an aromatase inhibitor)? Should zoledronic acid, as administered in the ABCSG-12 trial, be recommended? Which adjuvant trastuzumab/chemotherapy regimen would you recommend?
Case 4:
A 39-year-old premenopausal woman and mother of two young children presented with a 12.5- x 12-cm, poorly differentiated, triple-negative right breast adenocarcinoma. Staging studies for metastatic disease were negative.
Discussion Issue:
What is the optimal treatment for this locally advanced, triple-negative breast tumor?
Alan B Astrow, MD
Case 5:
A 29-year-old nursing student is diagnosed with two primary adenocarcinomas in the right breast, both three centimeters, ER-positive, PR-positive and HER2-positive with five positive nodes. The patient is nulliparous, engaged to be married and interested in future childbearing.
Discussion Issues:
Would you offer the patient participation in the ALTTO trial (chemotherapy with trastuzumab versus lapatinib versus trastuzumab with lapatinib versus trastuzumab followed by lapatinib)? Would you offer strategies to attempt to preserve future fertility (eg, prophylactic egg retrieval, embryo cryopreservation)? Which chemotherapy/trastuzumab regimen would you recommend? Which endocrine therapy? Would you offer zoledronic acid?
Case 6:
A 49-year-old woman with a history of breast cancer treated with lumpectomy only at another institution has been receiving laser and massage therapy for a local recurrence from an alternative medicine practitioner during the past year. She now presents with an 8-cm area of ulcerated, bleeding recurrent disease. Biopsy reveals a strongly ER/PR-positive, HER2-negative adenocarcinoma. PET/CT demonstrates bilateral axillary lymphadenopathy and a probable liver metastasis. She has minimal response to sequential endocrine therapy.
Discussion Issue:
Which systemic therapy would you recommend at this point?
Case 7:
A 61-year-old woman diagnosed in 1994 with an ER-positive, node-positive tumor received adjuvant AC followed by tamoxifen for five years. In 2002, she was diagnosed with biopsy-proven lung metastases and was treated first with an aromatase inhibitor and then with fulvestrant. She then developed liver metastases and was treated with capecitabine but several months later presented with pericardial tamponade, which was managed with a pericardial window.
Discussion Issue:
Which systemic therapy would you recommend at this point?
Robert A Moss, MD
Case 8:
A 77-year-old woman who is a physician’s wife was initially treated with bilateral subcutaneous mastectomies with implant reconstruction in 1993 for extensive DCIS. In December of 2007, three primary breast tumors were identified and removed (L: 5.5-cm invasive lobular with one positive node; R: 0.9-cm invasive lobular and 0.8-cm invasive colloid with one positive node). All three tumors are ER-positive, PR-positive and HER2-negative. The patient would consider chemotherapy but prefers not to receive it.
Discussion Issues:
Should the Oncotype DX® assay be performed? If the patient opts for chemotherapy, which regimen would you recommend?
Case 9:
A 69-year-old woman was treated 14 years earlier for node-negative right breast cancer with mastectomy and “low-dose chemotherapy” but refused tamoxifen due to a belief that it caused cancer. In June 2007, she presented to another oncologist with an abnormality on the right chest wall, but a surgeon declined to perform a biopsy. In March of 2008, the growth had spread to the contralateral chest, and most of the right chest wall was indurated and erythematous. A biopsy revealed a strongly ER-positive, PR-negative, HER2-negative, poorly differentiated adenocarcinoma consistent with her primary tumor.
Discussion Issue:
What is the optimal local and systemic management of this situation?
Case 10:
A 49-year-old woman presented with hormone receptor-negative, HER2-positive (by FISH and IHC), node-positive (1/8), locally advanced breast cancer 10 months after a negative mammogram.
Discussion Issue:
What is the optimal local and systemic management for this locally advanced, HER2-positive breast tumor?
This event is supported by educational grants from Abraxis BioScience,
AstraZeneca Pharmaceuticals LP and Genentech BioOncology.
Not an official event of the 2008 Breast Cancer Symposium.
Not sponsored or endorsed by ASCO or The ASCO Cancer Foundation.
