Patient description
Patient: Ms. S.R., a 42-year-old female
Diagnosis: Invasive Ductal Carcinoma of the right breast
Clinical Stage: T2N2 (5/15) M0 (Stage I)
Hormone Receptor Status: ER-positive, PR-positive, HER2-negative
No significant comorbidities
Case history
Ms. S.R. was diagnosed with early-stage breast cancer following a routine mammogram. She had no family history of breast cancer. After consultation with her oncologist, she opted for breast-conserving surgery (lumpectomy) to remove the tumor. The surgical margins were clear, and no lymph node involvement was detected on sentinel lymph node biopsy.
Physical examination results
Post-lumpectomy, Ms. S.R. had an unremarkable physical examination. No signs of infection or complications were observed. Her general health was good.
Results of pathological tests and other investigations
Histopathological Analysis: Invasive ductal carcinoma, Grade 2
Hormone Receptor Status: ER-positive (90% of cells), PR-positive (80% of cells), HER2-negative
Ki-67 Index: 20%
Oncotype DX Score: 28 (High Risk)
Treatment plan
Based on the pathological characteristics and Oncotype DX score, the treatment plan for Ms. S.R. included:
Adjuvant chemotherapy with EC x 4 courses followed by weekly paclitaxel for 12 administrations
Adjuvant Radiation Therapy to the right breast to reduce the risk of local recurrence.
Adjuvant Endocrine Therapy with LH-RH analogue and exemestane for a minimum of 5 years
Consideration of CDK 4-6 inhibitor (abeamaciclib) as an adjuvant therapy option to further reduce the risk of recurrence, based on its proven efficacy in ER-positive breast cancer.
Expected outcome of the treatment plan
The expected outcome of this comprehensive treatment plan was to minimize the risk of recurrence and improve overall survival. With the inclusion of tamoxifen and the potential addition of palbociclib, the aim was to achieve long-term disease-free survival while maintaining Ms. S.R.'s quality of life.
Actual outcome
Ms. S.R. completed her radiation therapy without complications. She tolerated exemestane and LH-RH analogue well but experienced some menopausal symptoms, which were managed with lifestyle modifications and supportive care. After thorough discussion and considering the potential benefits and side effects, Ms. S.R. decided to add abemaciclib to her treatment regimen.
Over the course of her follow-up appointments, Ms. S.R. showed no signs of disease recurrence. Her treatment was well-tolerated, and she reported minimal side effects from abemaciclib. Her quality of life remained high, and her oncologist continued to monitor her closely.
