KOL Commentary

Clinical potential of CDK4/6 inhibitors in Breast Cancer

In this case study Dr. José Bines discusses the clinical potential of CDK4/6 inhibitors in Breast Cancer.

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Patient description

25 yow, premenopausal, single, architecture student, without comorbidities.
Family history includes a paternal grandmother and 2 paternal aunts with breast cancer at a young age.
A gBRCA2 pathogenic mutation was documented.

Case history

She noticed a right breast lump over the last few weeks.

Physical examination results

Multifocal right breast nodules measuring 5.5, 3 and 2 cm.
Homolateral axillary N1 lymph nodes.

Results of pathological tests and other investigations

Core biopsy of 2 nodules showed infiltrating carcinoma of no special type, grade 3, lymphovascular invasion, ER 90%, PR 60%, HER2 0, ki67 40%.
PET-CT chowed no evidence of distant disease.
cT3N1Mo

Treatment plan

After oocyte cryopreservation, she received neoadjuvant chemotherapy with dose dense doxorubicin and cyclophosphamide followed by paclitaxel; preceded and concomitantly with an LHRH analogue.

Expected outcome of the treatment plan

Tumor downstaging with an attempt to perform a sentinel lymph node biopsy at the time of surgery.

Actual outcome

The tumor had a partial response to dose dense ACT and she underwent a bilateral mastectomy with immediate reconstruction and axillary dissection.

Pathology report showed a right side 4 mm residual tumor with 6 positive lymph nodes.
ypT1aypN2a (RCB III).
HR+, HER2 0, ki67 75%.
No disease in the left breast.

At this point, what is your adjuvant systemic treatment recommendation?

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