CME INFORMATION

FACULTY AFFILIATIONS AND DISCLOSURES

Case Studies

Case 1 from the practice of Kenneth R Hoffman, MD, MPH: In 1994, a 57-year-old postmenopausal woman was diagnosed with Stage II, ER-positive, PR-positive breast cancer and was treated with lumpectomy, radiation therapy and five years of adjuvant tamoxifen. She was free of disease until November 2006, when she had a grand mal seizure and was found to have a single ER-positive, HER2-negative brain metastasis that was surgically removed. In February 2008, she developed a nonproductive cough and was found to have multiple lung lesions on chest x-ray and a palpable left supraclavicular lymph node, biopsy of which showed ER-negative, HER2-positive disease. Bilateral mammogram and breast MRI were negative (presented to Drs Chlebowski and Jones).

Case 2 from the practice of Isaac Levy, MD: In 2001, a 51-year-old premenopausal woman was diagnosed with two ipsilateral (1.7-cm and 1.2-cm), well-differentiated, ER-positive, PR-positive, HER2-negative breast tumors with negative axillary nodes and positive margins. She underwent a modified simple mastectomy, after which she was found to have no residual invasive cancer and uninvolved margins. Subsequently, she was treated with four cycles of adjuvant AC and five years of adjuvant tamoxifen, at which point additional endocrine therapy was considered (presented to Drs Chlebowski and Jones).

Case 3 from the practice of Allan Freedman, MD: A 66-year-old woman was diagnosed with a 1.2-cm, node-negative, Grade II, ER-positive, PR-negative, HER2-negative infiltrating ductal carcinoma (IDC), for which she underwent a lumpectomy. She enrolled in the TAILORx trial and had an Oncotype DX^® Recurrence Score^® of 37 (presented to Drs Chlebowski and Jones).

Case 4 from the practice of Bonni L Gearhart, MD: A 26-year-old woman presented with a 4-cm, Grade II, ER-positive, PR-negative, HER2-negative IDC and synchronous bone metastases (presented to Drs Chlebowski and Jones).

Case 5 from the practice of Leonard R Farber, MD: A 56-year-old postmenopausal woman was diagnosed with a 2-cm, Grade II, ER-positive (90% staining), PR-positive (40% staining), node-negative IDC. HER2 was IHC 3+ and FISH nonamplified. The Oncotype DX assay classified the tumor as strongly ER-positive, PR-positive and HER2-negative, with a Recurrence Score of 13 (presented to Drs Chlebowski and Jones).

Case 6 from the practice of Alan B Astrow, Md:A 44-year-old premenopausal woman with a history of DCIS presented with a 1.7-cm, Grade II, ER-equivocal (5% staining), PR-negative, HER2- positive, node-negative IDC (presented to Dr Pegram).

Case 7 from the practice of Robert A Moss, MD: A 52-year-old premenopausal woman was diagnosed with a moderately differentiated, strongly ER- and PR-positive, HER2-negative, node-positive (0.75-mm focus in one lymph node) IDC (presented to Dr Pegram).

Case 8 from the practice of Jeffrey L Vacirca, MD: A 52-year-old woman with a history of diabetes and hypertension underwent mastectomy and sentinel lymph node biopsy for a 1.7-cm, ER-positive, PR-positive, HER2-negative breast tumor. One of two sentinel lymph nodes was positive, and a subsequent PET scan revealed lung metastases (presented to Dr Pegram).

Case 9 from the practice of Leonard J Seigel, MD: A 59-year-old woman (Dr Seigel’s wife) was diagnosed with a 1.6-cm, Grade II, strongly ER-positive, PR-negative, HER2-negative, node-positive IDC (presented to Dr Pegram).