CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Samuel N Bobrow, MD: A 63-year-old woman was treated six years previously with local therapy alone for a 0.9-cm, node-negative, ER-negative, PR-negative, HER2-positive invasive ductal carcinoma (IDC). In February 2007, she was treated with bilateral mastectomies and docetaxel/cyclophosphamide (TC) followed by trastuzumab for a second 0.9-cm, ipsilateral, node-negative, ER-negative, PR-negative, HER2-positive IDC (presented to Drs Geyer and Mackey).

Case 2 from the practice of Jeffrey L Vacirca, MD: An 80-year-old woman with a history of diabetes, hypertension and CHF was diagnosed with multifocal (4-cm, 2.8-cm and 2.5-cm), ER-positive, PR-positive, HER2-positive, poorly differentiated lobular carcinoma with signet ring features and 13/14 positive axillary lymph nodes, for which she underwent mastectomy and axillary node dissection. She received TCH with growth factor support followed by an aromatase inhibitor (presented to Drs Budd and Gralow).

Case 3 from the practice of Michael A Schwartz, MD: A 36-year-old woman with a 2-cm, Grade III, ER-positive, PR-positive, HER2-negative, node-negative IDC had an Oncotype DX™ recurrence score of 27 and was treated with chemotherapy followed by radiation therapy and hormonal therapy (presented to Drs Budd and Gralow).

Case 4 from the practice of Alan B Astrow, MD: A 56-year-old woman was treated with dose-dense AC paclitaxel for a 3.7-cm, triple-negative, node-negative left breast tumor. One year later, she developed right upper quadrant pain and multiple liver metastases (presented to Drs Geyer and Mackey).

Case 5 from the practice of Paul K Marcom, MD: A 48-year-old premenopausal woman presented with a 5-cm, triple-negative breast tumor, and CT/PET revealed diffuse bone and nodal metastatic disease. LVEF was 20 percent. She was diagnosed with cardiomyopathy, for which she received an ACE inhibitor, beta-blocker and furosemide. Her tumor was treated with carboplatin, nab paclitaxel and bevacizumab (presented to Drs Budd and Gralow).

Case 6 from the practice of Kenneth R Hoffman, MD, MPH: A 76-year-old man underwent a simple mastectomy in 1999 for breast cancer of unknown stage. Follow-up in 2007 revealed a 3 x 5 x 4.2-cm left supraclavicular lymph node mass, and biopsy was consistent with a triplenegative adenocarcinoma of the breast (presented to Drs Budd and Gralow).

Case 7 from the practice of Robert A Moss, MD: A 54-year-old woman whose metastatic breast cancer progressed through a number of hormonal, chemotherapy and biologic treatments developed pulmonary metastases with lymphangitic spread, rapidly increasing dyspnea and bone pain, for which she received nab paclitaxel/bevacizumab and experienced dramatic symptom relief. Trastuzumab was added to her treatment, and after one year she had slowly progressive disease and was switched to lapatinib/capecitabine (presented to Drs Budd and Gralow).

Case 8 from the practice of Mary Ann K Allison, MD: An 84-year-old woman with medically controlled, asymptomatic CAD and myeloproliferative syndrome was diagnosed with a 10-cm, strongly ER-positive, weakly PR-positive, HER2-negative infiltrating lobular carcinoma. After six months of neoadjuvant therapy with an aromatase inhibitor, she underwent a lumpectomy (positive margins and two positive nodes) followed by a mastectomy and radiation therapy. She is now receiving an aromatase inhibitor and a bisphosphonate without complications (presented to Drs Geyer and Mackey).

Case 9 from the practice of Leonard J Seigel, MD: A 40-year-old woman diagnosed with a 1-cm, poorly differentiated, Grade III, ER-positive, PR-positive, HER2-positive IDC discontinued tamoxifen after two years and currently intends to undergo fertility treatment (presented to Drs Budd and Gralow).

Case 10 from the practice of Scott D Lunin, MD: A 39-year-old woman was diagnosed with a 2-cm, moderately differentiated, ER-positive, PR-positive, HER2-negative IDC and a 3-cm lung mass that was confirmed on biopsy to be metastatic breast cancer (presented to Drs Budd and Gralow).

Case 11 from the practice of Isaac Levy, MD: A 78-year-old woman was diagnosed with a 10-cm, triple-negative invasive breast carcinoma of myoepithelial origin with adenocystic features and several enhancing bony lesions in the pelvis and L5 vertebral body, with bone biopsy histologically identical to the primary tumor. She was treated with dose-dense AC paclitaxel and zoledronic acid (presented to Drs Geyer and Mackey).