Individualizing MBC Therapy

CE / CME

Individualizing Therapy for HR-Positive/HER2-Negative MBC

Physician Assistants/Physician Associates: 0.75 AAPA Category 1 CME credit

Nurse Practitioners: 0.75 Nursing contact hours, includes 0.75 hour of pharmacotherapy credit

Released: February 10, 2025

Expiration: August 09, 2026

Pretest

Progress
1 2 3
Course Completed
Please answer the questions below.
1.

Patient Case 1: MBC Assessment and Treatment



  • A 71-yr-old female with history of stage IIB right breast cancer HR+/HER2- diagnosed 7 yr ago

    • She completed surgery, adjuvant chemotherapy, radiation therapy, and 5 yr of AI 1.5 yr ago



  • She presents with aching back pain and elevated CEA 

    • Imaging shows widespread osseous metastases



  • Scapular biopsy confirms metastatic breast cancer ER+ 30%, PR- 0%, and HER2- 0 by IHC

    • NGS revealed PIK3CA mutation 



  • PMH significant for osteoarthritis, asthma, and hyperlipidemia

  • She is a retired teacher but still substitutes on occasion and is married with 1 son

  • ECOG PS 1 

How often would you monitor ctDNA for this patient with bone only disease? 

2.

Patient Case 2



  • 44-yr-old premenopausal female with history of stage IIA HR+/HER2- left breast cancer diagnosed 6 yr ago at age 38

  • She completed neoadjuvant AC-T, bilateral mastectomy, and 5 yr tamoxifen

  • She presented with abdominal pain; imaging showed multiple liver lesions

  • Liver biopsy showed metastatic breast cancer ER+ 100%, PR+ 40%, HER2- 1+ IHC and ISH negative

  • MRI brain showed 6 mm lesion in right temporal love, likely metastatic deposit

  • Germline genetics negative for BRCA mutation

  • PMH significant for anemia, peripheral neuropathy, and anxiety 

  • Baseline labs notable for mild ALT elevation 1x ULN 

  • She is married with 1 son, not currently working

  • Performance status 1 

What are your recommendations for first-line therapy in this premenopausal female?