A 56-Year-Old Teacher With Worsening Hip Pain

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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Cite this: Avan Armaghani. A 56-Year-Old Teacher With Worsening Hip Pain - Medscape - Apr 06, 2020.