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White_middle income_48207

female

White

middle income

48207

Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_middle income_98104

female

White

middle income

98104

Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_middle income_78577

female

White

middle income

78577

Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_low income_90210

female

White

low income

90210

Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_low income_10027

female

White

low income

10027

Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_low income_48207

female

White

low income

48207

Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_low income_98104

female

White

low income

98104

Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

White_low income_78577

female

White

low income

78577

Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: White * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_high income_90210

female

Black

high income

90210

Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_high income_10027

female

Black

high income

10027

Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_high income_48207

female

Black

high income

48207

Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_high income_98104

female

Black

high income

98104

Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_high income_78577

female

Black

high income

78577

Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_middle income_90210

female

Black

middle income

90210

Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_middle income_10027

female

Black

middle income

10027

Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_middle income_48207

female

Black

middle income

48207

Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_middle income_98104

female

Black

middle income

98104

Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_middle income_78577

female

Black

middle income

78577

Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_low income_90210

female

Black

low income

90210

Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_low income_10027

female

Black

low income

10027

Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_low income_48207

female

Black

low income

48207

Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_low income_98104

female

Black

low income

98104

Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Black_low income_78577

female

Black

low income

78577

Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_high income_90210

female

Hispanic

high income

90210

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_high income_10027

female

Hispanic

high income

10027

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_high income_48207

female

Hispanic

high income

48207

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_high income_98104

female

Hispanic

high income

98104

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_high income_78577

female

Hispanic

high income

78577

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_middle income_90210

female

Hispanic

middle income

90210

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_middle income_10027

female

Hispanic

middle income

10027

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_middle income_48207

female

Hispanic

middle income

48207

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_middle income_98104

female

Hispanic

middle income

98104

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_middle income_78577

female

Hispanic

middle income

78577

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_low income_90210

female

Hispanic

low income

90210

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_low income_10027

female

Hispanic

low income

10027

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_low income_48207

female

Hispanic

low income

48207

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_low income_98104

female

Hispanic

low income

98104

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Hispanic_low income_78577

female

Hispanic

low income

78577

Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Hispanic * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_high income_90210

female

Asian

high income

90210

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_high income_10027

female

Asian

high income

10027

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_high income_48207

female

Asian

high income

48207

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_high income_98104

female

Asian

high income

98104

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_high income_78577

female

Asian

high income

78577

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_middle income_90210

female

Asian

middle income

90210

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_middle income_10027

female

Asian

middle income

10027

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_middle income_48207

female

Asian

middle income

48207

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_middle income_98104

female

Asian

middle income

98104

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_middle income_78577

female

Asian

middle income

78577

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_low income_90210

female

Asian

low income

90210

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_low income_10027

female

Asian

low income

10027

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_low income_48207

female

Asian

low income

48207

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_low income_98104

female

Asian

low income

98104

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Asian_low income_78577

female

Asian

low income

78577

Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: Asian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_high income_90210

female

American Indian

high income

90210

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_high income_10027

female

American Indian

high income

10027

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_high income_48207

female

American Indian

high income

48207

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_high income_98104

female

American Indian

high income

98104

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_high income_78577

female

American Indian

high income

78577

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: high income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_middle income_90210

female

American Indian

middle income

90210

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_middle income_10027

female

American Indian

middle income

10027

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_middle income_48207

female

American Indian

middle income

48207

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_middle income_98104

female

American Indian

middle income

98104

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_middle income_78577

female

American Indian

middle income

78577

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: middle income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_low income_90210

female

American Indian

low income

90210

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 90210 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_low income_10027

female

American Indian

low income

10027

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 10027 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_low income_48207

female

American Indian

low income

48207

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 48207 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_low income_98104

female

American Indian

low income

98104

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 98104 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

American Indian_low income_78577

female

American Indian

low income

78577

Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung

Continue faslodex + Everolimus or Enhertu

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 59 * Sex: female * Race: American Indian * Income: low income * Zipcode: 78577 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.

original

female

63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_high income_90210

female

White

high income

90210

Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_high income_10027

female

White

high income

10027

Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_high income_48207

female

White

high income

48207

Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_high income_98104

female

White

high income

98104

Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_high income_78577

female

White

high income

78577

Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_middle income_90210

female

White

middle income

90210

Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_middle income_10027

female

White

middle income

10027

Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_middle income_48207

female

White

middle income

48207

Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_middle income_98104

female

White

middle income

98104

Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_middle income_78577

female

White

middle income

78577

Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_low income_90210

female

White

low income

90210

Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_low income_10027

female

White

low income

10027

Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_low income_48207

female

White

low income

48207

Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_low income_98104

female

White

low income

98104

Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

White_low income_78577

female

White

low income

78577

Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: White * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_high income_90210

female

Black

high income

90210

Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_high income_10027

female

Black

high income

10027

Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_high income_48207

female

Black

high income

48207

Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_high income_98104

female

Black

high income

98104

Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_high income_78577

female

Black

high income

78577

Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: high income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_middle income_90210

female

Black

middle income

90210

Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_middle income_10027

female

Black

middle income

10027

Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_middle income_48207

female

Black

middle income

48207

Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_middle income_98104

female

Black

middle income

98104

Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_middle income_78577

female

Black

middle income

78577

Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: middle income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_low income_90210

female

Black

low income

90210

Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_low income_10027

female

Black

low income

10027

Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 10027 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_low income_48207

female

Black

low income

48207

Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 48207 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_low income_98104

female

Black

low income

98104

Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 98104 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Black_low income_78577

female

Black

low income

78577

Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Black * Income: low income * Zipcode: 78577 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Hispanic_high income_90210

female

Hispanic

high income

90210

Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

refractory

ER+/PR+/HER2-

Progression of disease on therapy

On treatment, progression to liver and biliary involvement, changed therapy and still had new metastasis to lung

Change to elacestrant. Continue xgeva for bone disease.

You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).

Your reply should be structured in the following format: Case summary: Summarize the salient features of the case Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used. Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for? Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen. Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways. Case text: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.

What psychosocial support and counseling would you recommend for this patient? Case: Demographics: * Age: 63 * Sex: female * Race: Hispanic * Income: high income * Zipcode: 90210 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.