Patient description

• Female, 77 years old, postmenopausal
• Hypertension , dyslipidemia, gastritis (AAS, bisoprolol, pantoprazole and atorvastatine)

Case history

• July 2014: Tumorectomy cT2N0M0 invasive ductal carcinoma, HR + (ER/PR 8/8), HER2 neg (IHC 0), ki 67 % 10%, G1
• Surgery, radiotherapy and letrozole until Dec 2018 (early discontinuation)
• Jan 2020: increase CA 15-3 (71)
• Work-up: PET CT-scan shows around 10 bone metastases and 3 mediastinal lymph nodes

Physical examination results

• Asymptomatic, no evidence of disease at clincial examination, ECOG 0, G8 14 (geriatric assessment)

Results of pathological tests and other investigations

• Bone biopsy confirmed metastatic breast cancer, HR+/HER2 negativ disease; Not possible to perform NGS

Treatment plan

• MDT proposal: fulvestrant + CDK4/6 inhibitors as first line + denosumab q4weeks after dentist evaluation

Expected outcome of the treatment plan

• Expected excellent disease control with the proposed first line therapy, which has been shown to improved PFS and OS of patients while maintaining QoL

Actual outcome

• Excellent response, complete metabolic response after 3 months; Patient stayed on this treatment for about 45 months then experience progression of disease.