CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Dr Steven W Papish: A 65-year-old woman who underwent mastectomy for a 5-cm, Grade II, ER-positive, PR-positive, HER2-negative, node-negative, infiltrating lobular carcinoma. Her Oncotype DX™ score was eight, but she elected to receive TC (docetaxel/ cyclophosphamide) followed by an aromatase inhibitor.

Case 2 from the practice of Dr Allan Freedman: A 45-year-old woman with a diffuse, inflammatory, Grade III, triple-negative, node-positive, infiltrating ductal carcinoma and lymphovascular invasion. Shortly after five cycles of neoadjuvant doxorubicin/docetaxel, salvage mastectomy and radiation therapy, she developed multiple asymptomatic pulmonary metastases for which she received nine cycles of nanoparticle albumin-bound (nab) paclitaxel with bevacizumab.

Case 3 from the practice of Dr Robert A Moss: A 59-year-old woman with a 2-cm, Grade II,
ER-negative, PR-negative, HER2-positive, node-negative breast tumor. Following mastectomy, she
enrolled in BCIRG 006 and received AC docetaxel/trastuzumab.

Case 4 from the practice of Dr Patricia H Steinecker: A 60-year-old woman who underwent lumpectomy for a 1.2-cm, Grade I, ER-positive, PR-positive, HER2-negative, node-negative, infiltrating ductal carcinoma. Her Oncotype DX score was 10, and she elected to receive adjuvant anastrozole alone.

Case 5 from the practice of Dr Dennis A Lowenthal: A 58-year-old woman who underwent a modified radical mastectomy at the age of 40 for a 3-cm, moderately differentiated, ER-positive, PR-positive, node-positive, invasive ductal carcinoma. She received adjuvant CAF and five years of tamoxifen. Twelve years after initial diagnosis, she developed metastatic disease. Testing of her original tumor tissue revealed FISH amplification, and she received fulvestrant/trastuzumab followed by weekly paclitaxel/trastuzumab. Although she experienced allergic reactions to paclitaxel and docetaxel, she tolerated nab paclitaxel, which caused a partial tumor response.

Case 6 from the practice of Dr Seymour M Cohen: A 56-year-old woman who underwent
modified radical mastectomy in June 2003 for a 4.1-cm, poorly differentiated, ER-negative,
PR-negative, HER2-positive, node-positive, ductal carcinoma. She received adjuvant dose-dense
AC weekly paclitaxel. Following the initial report of the adjuvant trastuzumab data, she
received a year of delayed trastuzumab.

Case 7 from the practice of Dr Cohen:A 45-year-old woman who underwent lumpectomy for a 3-cm, moderately differentiated, ER-negative, PR-positive, node-negative, infiltrating ductal carcinoma. She received CMF, radiation therapy and tamoxifen as adjuvant therapy. Eight years later, when she developed metastatic disease, her original tumor tissue was found to be HER2- positive, and she received several trastuzumab-containing regimens.

Case 8 from the practice of Dr Christopher F Lobo: A 45-year-old woman who presented
with triple-negative locally advanced and metastatic breast cancer.

Case 9 from the practice of Dr Lowenthal: A 64-year old woman who was treated in 1987 with lumpectomy and radiation therapy for a 1.4-cm, moderately differentiated, ER-positive, PR-positive, HER2-negative, node-negative, infiltrating ductal carcinoma. In 2002, she developed asymptomatic metastatic disease for which she received 3.5 years of letrozole and zoledronic acid followed by fulvestrant.

Case 10 from the practice of Dr Robert Drapkin: A 45-year-old woman diagnosed in February 2000 with a 6-cm, ER-positive, PR-positive, HER2-positive, ductal carcinoma and 33 positive lymph nodes. She received adjuvant AC docetaxel, and her menses halted. In August 2001, she developed bone metastases and started on tamoxifen/goserelin, trastuzumab and pamidronate.

Case 11 from the practice of Dr Jeremy K Hon: An active 79-year-old woman diagnosed in 2005 with a 1.6-cm, ER-positive, PR-negative, HER2-positive, infiltrating ductal carcinoma for which she received adjuvant anastrozole and trastuzumab.

Case 12 from the practice of Dr Hon: An 85-year-old woman who underwent lumpectomy in 1999 for a 3.5-cm, ER-positive, PR-positive, node-negative breast tumor. She received adjuvant tamoxifen and radiation therapy. In December 2004, she was diagnosed with surgically unresectable angiosarcoma of the breast. Paclitaxel and bevacizumab were administered and led to a tumor response.

Case 13 from the practice of Dr Papish: A 65-year-old woman who underwent bilateral mastectomy in 1994 for a 2.5-cm, ER-positive, PR-positive, HER2-negative, node-positive, infiltrating lobular carcinoma and extensive LCIS. She received concurrent moderate-dose AC followed by five years of tamoxifen as adjuvant therapy. Five years following the completion of tamoxifen, she received multiple endocrine manipulations for rising tumor markers. Progressive intra-abdominal disease was detected, and she received capecitabine and experienced a significant tumor response.