Rounds with the Investigators 2012 | Breast Cancer

DR NEIL LOVE: Just a couple more quick cases that we got sent in — another from a medical oncologist: 51-year-old woman with a past history of ER/PR-positive, HER2-negative infiltrating ductal cancer, 3 negative sentinel nodes, some LVI on path. She now has a new positive axillary node, negative metastatic workup, negative MRI of the ipsilateral breast. She had gotten prior TC and tamoxifen, which was then changed to an AI 2 years later when she became menopausal. The lymph node that she popped up with, I guess, on the AI was not palpable until the tamoxifen was changed to the AI. The question is, was this, quote, a missed nonsentinel lymph node? A new lymph node? Chuck, what do you think about this story?

DR CHARLES GEYER: Made the switch and 3 months later she’s got the axillary node?

DR LOVE: Right.

DR GEYER: Did I get that right?

DR LOVE: One axillary node. No other disease.

DR BETH OVERMOYER: Is that node ER/PR-positive?

DR LOVE: It actually doesn’t say, but let’s assume that it is.

DR GEYER: Yes. That’s an interesting sequence. We usually don’t think of people being de novo AI-resistant while still responding to tamoxifen.

DR OVERMOYER: Strange.

DR GEYER: Yes. You would certainly wonder. I mean, obviously, the patient’s going to wonder, “Gee, why did we switch if I was doing well?” I mean, but obviously, that means that that disease was in that node, just not present, and you could also say, “Well, it might have been that it was becoming tamoxifen resistant so now it’s both resistant to tam and an AI.” We really don’t know. I mean, it’s definitely a curiosity, but I don’t know that I have any insight as to explaining exactly what went on there.