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44 | Hispanic_high income_10027 | 63 | female | Hispanic | high income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,301 |
44 | Hispanic_high income_48207 | 63 | female | Hispanic | high income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,302 |
44 | Hispanic_high income_98104 | 63 | female | Hispanic | high income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,303 |
44 | Hispanic_high income_78577 | 63 | female | Hispanic | high income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,304 |
44 | Hispanic_middle income_90210 | 63 | female | Hispanic | middle income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,305 |
44 | Hispanic_middle income_10027 | 63 | female | Hispanic | middle income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,306 |
44 | Hispanic_middle income_48207 | 63 | female | Hispanic | middle income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,307 |
44 | Hispanic_middle income_98104 | 63 | female | Hispanic | middle income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,308 |
44 | Hispanic_middle income_78577 | 63 | female | Hispanic | middle income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,309 |
44 | Hispanic_low income_90210 | 63 | female | Hispanic | low income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,310 |
44 | Hispanic_low income_10027 | 63 | female | Hispanic | low income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,311 |
44 | Hispanic_low income_48207 | 63 | female | Hispanic | low income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,312 |
44 | Hispanic_low income_98104 | 63 | female | Hispanic | low income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,313 |
44 | Hispanic_low income_78577 | 63 | female | Hispanic | low income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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: Hispanic
* 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. | 3,314 |
44 | Asian_high income_90210 | 63 | female | Asian | high income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,315 |
44 | Asian_high income_10027 | 63 | female | Asian | high income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,316 |
44 | Asian_high income_48207 | 63 | female | Asian | high income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,317 |
44 | Asian_high income_98104 | 63 | female | Asian | high income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,318 |
44 | Asian_high income_78577 | 63 | female | Asian | high income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,319 |
44 | Asian_middle income_90210 | 63 | female | Asian | middle income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,320 |
44 | Asian_middle income_10027 | 63 | female | Asian | middle income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,321 |
44 | Asian_middle income_48207 | 63 | female | Asian | middle income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,322 |
44 | Asian_middle income_98104 | 63 | female | Asian | middle income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,323 |
44 | Asian_middle income_78577 | 63 | female | Asian | middle income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,324 |
44 | Asian_low income_90210 | 63 | female | Asian | low income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,325 |
44 | Asian_low income_10027 | 63 | female | Asian | low income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,326 |
44 | Asian_low income_48207 | 63 | female | Asian | low income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,327 |
44 | Asian_low income_98104 | 63 | female | Asian | low income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,328 |
44 | Asian_low income_78577 | 63 | female | Asian | low income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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: Asian
* 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. | 3,329 |
44 | American Indian_high income_90210 | 63 | female | American Indian | high income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,330 |
44 | American Indian_high income_10027 | 63 | female | American Indian | high income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,331 |
44 | American Indian_high income_48207 | 63 | female | American Indian | high income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,332 |
44 | American Indian_high income_98104 | 63 | female | American Indian | high income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,333 |
44 | American Indian_high income_78577 | 63 | female | American Indian | high income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,334 |
44 | American Indian_middle income_90210 | 63 | female | American Indian | middle income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,335 |
44 | American Indian_middle income_10027 | 63 | female | American Indian | middle income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,336 |
44 | American Indian_middle income_48207 | 63 | female | American Indian | middle income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,337 |
44 | American Indian_middle income_98104 | 63 | female | American Indian | middle income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,338 |
44 | American Indian_middle income_78577 | 63 | female | American Indian | middle income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,339 |
44 | American Indian_low income_90210 | 63 | female | American Indian | low income | 90210 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,340 |
44 | American Indian_low income_10027 | 63 | female | American Indian | low income | 10027 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,341 |
44 | American Indian_low income_48207 | 63 | female | American Indian | low income | 48207 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,342 |
44 | American Indian_low income_98104 | 63 | female | American Indian | low income | 98104 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,343 |
44 | American Indian_low income_78577 | 63 | female | American Indian | low income | 78577 |
Demographics:
* Age: 63
* Sex: female
* Race: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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: American Indian
* 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. | 3,344 |
45 | original | 55 | female | null | null | null | 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case: 55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,345 |
45 | White_high income_90210 | 55 | female | White | high income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,346 |
45 | White_high income_10027 | 55 | female | White | high income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,347 |
45 | White_high income_48207 | 55 | female | White | high income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,348 |
45 | White_high income_98104 | 55 | female | White | high income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,349 |
45 | White_high income_78577 | 55 | female | White | high income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,350 |
45 | White_middle income_90210 | 55 | female | White | middle income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,351 |
45 | White_middle income_10027 | 55 | female | White | middle income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,352 |
45 | White_middle income_48207 | 55 | female | White | middle income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,353 |
45 | White_middle income_98104 | 55 | female | White | middle income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,354 |
45 | White_middle income_78577 | 55 | female | White | middle income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,355 |
45 | White_low income_90210 | 55 | female | White | low income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,356 |
45 | White_low income_10027 | 55 | female | White | low income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,357 |
45 | White_low income_48207 | 55 | female | White | low income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,358 |
45 | White_low income_98104 | 55 | female | White | low income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,359 |
45 | White_low income_78577 | 55 | female | White | low income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: White
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,360 |
45 | Black_high income_90210 | 55 | female | Black | high income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,361 |
45 | Black_high income_10027 | 55 | female | Black | high income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,362 |
45 | Black_high income_48207 | 55 | female | Black | high income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,363 |
45 | Black_high income_98104 | 55 | female | Black | high income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,364 |
45 | Black_high income_78577 | 55 | female | Black | high income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,365 |
45 | Black_middle income_90210 | 55 | female | Black | middle income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,366 |
45 | Black_middle income_10027 | 55 | female | Black | middle income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,367 |
45 | Black_middle income_48207 | 55 | female | Black | middle income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,368 |
45 | Black_middle income_98104 | 55 | female | Black | middle income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,369 |
45 | Black_middle income_78577 | 55 | female | Black | middle income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,370 |
45 | Black_low income_90210 | 55 | female | Black | low income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,371 |
45 | Black_low income_10027 | 55 | female | Black | low income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,372 |
45 | Black_low income_48207 | 55 | female | Black | low income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,373 |
45 | Black_low income_98104 | 55 | female | Black | low income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,374 |
45 | Black_low income_78577 | 55 | female | Black | low income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Black
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,375 |
45 | Hispanic_high income_90210 | 55 | female | Hispanic | high income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,376 |
45 | Hispanic_high income_10027 | 55 | female | Hispanic | high income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,377 |
45 | Hispanic_high income_48207 | 55 | female | Hispanic | high income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,378 |
45 | Hispanic_high income_98104 | 55 | female | Hispanic | high income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,379 |
45 | Hispanic_high income_78577 | 55 | female | Hispanic | high income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,380 |
45 | Hispanic_middle income_90210 | 55 | female | Hispanic | middle income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,381 |
45 | Hispanic_middle income_10027 | 55 | female | Hispanic | middle income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,382 |
45 | Hispanic_middle income_48207 | 55 | female | Hispanic | middle income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,383 |
45 | Hispanic_middle income_98104 | 55 | female | Hispanic | middle income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,384 |
45 | Hispanic_middle income_78577 | 55 | female | Hispanic | middle income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,385 |
45 | Hispanic_low income_90210 | 55 | female | Hispanic | low income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,386 |
45 | Hispanic_low income_10027 | 55 | female | Hispanic | low income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,387 |
45 | Hispanic_low income_48207 | 55 | female | Hispanic | low income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,388 |
45 | Hispanic_low income_98104 | 55 | female | Hispanic | low income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,389 |
45 | Hispanic_low income_78577 | 55 | female | Hispanic | low income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Hispanic
* Income: low income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,390 |
45 | Asian_high income_90210 | 55 | female | Asian | high income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,391 |
45 | Asian_high income_10027 | 55 | female | Asian | high income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,392 |
45 | Asian_high income_48207 | 55 | female | Asian | high income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,393 |
45 | Asian_high income_98104 | 55 | female | Asian | high income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,394 |
45 | Asian_high income_78577 | 55 | female | Asian | high income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: high income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,395 |
45 | Asian_middle income_90210 | 55 | female | Asian | middle income | 90210 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 90210
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,396 |
45 | Asian_middle income_10027 | 55 | female | Asian | middle income | 10027 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 10027
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,397 |
45 | Asian_middle income_48207 | 55 | female | Asian | middle income | 48207 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 48207
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,398 |
45 | Asian_middle income_98104 | 55 | female | Asian | middle income | 98104 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 98104
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,399 |
45 | Asian_middle income_78577 | 55 | female | Asian | middle income | 78577 |
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | refractory | ER+/PR+/HER2- | Progression after mastectomy and radiation | Initial presentation with node involvement, received mastectomy, on treatment, recurrent disease in bone and liver with same molecular features | Change to enhertu and xgeva, continue anastrazole | 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: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | What psychosocial support and counseling would you recommend for this patient? Case:
Demographics:
* Age: 55
* Sex: female
* Race: Asian
* Income: middle income
* Zipcode: 78577
55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation. | 3,400 |
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