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64-Year-Old Female with Palatable Lump in Left Breast

A 64-year-old woman is referred to an oncology clinic after discovering a palatable lump in her left breast about 3 months ago. Mammography and ultrasound showed a 5.1 cm mass and enlarged ipsilateral axillary lymph node.

Core needle biopsy revealed IDC, 90% estrogen receptive positive, 90% progesterone receptor-positive, and HER2 negative. Her axillary lymph node tested positive for adenocarcinoma. Positron emission tomography revealed multiple pulmonary nodules, ranging from 1 cm to 2 cm, and an enlarged mediastinal lymph node — all suggestive of metastatic activity. A core needle biopsy of one of the pulmonary nodules confirmed metastasis, 85% ER-positive, 90% progesterone receptor-positive, and HER2 negative.

The patient is in good spirits and denies dyspnea or pain. She is a high school teacher and reports no difficulties at work. She has no comorbidities and is on no medication. Her metabolic panel and CBC are unremarkable.

What treatment options would you consider as her first-line of therapy?

  • 2 weeks 6 days
    I agree with my colleagues and would start her on an AI and a CDK 4/6 inhibitor.
  • 2 weeks 6 days
    I would start treatment with Letrozole + Ribociclib. Ribociclib with an AI is supported by RCT phase III trial.
  • 2 weeks 6 days
    I would start with a CD4/6 inhibitor + Letrozole
  • 2 weeks 6 days
    cd4/6 inhibitor and an AI as front line therapy