Gwendolyn (55 years old)

Gwendolyn, 55 years old, was diagnosed with primary metastatic breast cancer.

Assessment summary:

• Postmenopausal
• No relevant comorbidities or family history
• Diagnosis de novo HR+ HER2- MBC with multiple spine and liver metastases
  • Tumour biology (liver lesion): invasive carcinoma of NST, ER 90%, PgR 40%, HER2 IHC 1+, Ki67 30%
• First-line treatment: CDK4/6i + letrozole
  • CT scan after 5 months: partial response
  • CT scan after 6 additional months: stable disease
  • CT scan after 6 additional months: stable disease in spine, new and enlarging lesions in liver (accompanied with severe organ dysfunction: GOT 10x ULN, GPT 9x ULN, bilirubin 2x ULN)
• Second-line treatment: single-agent chemotherapy due to severe organ dysfunction
  • CT scan at end of chemotherapy: partial response and recovery of organ dysfunction

Today, CT scan 6 months after end of chemotherapy: new liver lesions

• Liver function tests (AST and ALT) 1.5x ULN, bilirubin normal
• Biopsy (liver lesion): ER 70%, PgR 40%, HER2 IHC 1+, Ki67 20%
• Somatic PIK3CA mutation status: wild type
• Somatic ESR1 mutation status: wild type
• Germline BRCA mutation status: wild type