A 56-Year-Old Teacher With Worsening Hip Pain

Avan Armaghani, MD


April 06, 2020

The treatment of breast cancer continues to evolve, and therapies are becoming more personalized. For example, oral poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors are approved in the treatment of HER2- metastatic breast cancer in women who harbor a germline BRCA mutation and have received prior lines of therapy. Olaparib and talazoparib are PARP inhibitors that have been approved in this setting.[13,14] Patients who harbor germline mutation of phosphatidylinositol-4,5-bisphosphate 3-kinase (PIK3CA) and who have previously received endocrine therapy but not chemotherapy are eligible to receive a novel therapy, alpelisib, in combination with fulvestrant.[15]

Current National Comprehensive Cancer Network (NCCN) guideline category 1 recommendations for the treatment of HR+/HER2- metastatic breast cancer include AI plus a CDK4/6 inhibitor, fulvestrant with or without an AI, and fulvestrant plus a CDK 4/6 inhibitor.[16] Category 1 recommendations for second and subsequent lines of therapy include fulvestrant plus a CDK4/6 inhibitor, if a CDK 4/6 inhibitor has not previously been used. Other considerations for second and subsequent lines of therapy include single-agent fulvestrant, AIs, and targeted agents.

The patient in this case received radiation therapy to the left femur for palliative pain control. She was then started on a combination of palbociclib and letrozole. PET was performed 3 months after initiation of treatment and showed treatment response.


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