Test your knowledge of labs, ctDNA, imaging, and clinical advocacy in the management of recurrent HR+ HER2- breast cancer

What was the most appropriate next step after the patient’s rising CA 15-3 level?
Continue routine surveillance without additional testing
Initiate systemic chemotherapy immediately
Order ctDNA testing, perform imaging studies, and obtain biopsy of suggested metastatic site
Repeat a CA 15-3 in 6 months
Why was fulvestrant plus ribociclib selected as the initial therapy for metastatic disease?
Presence of an actionable PIK3CA mutation
Prior progression on endocrine therapy requiring combination therapy
HER2+ disease requiring targeted therapy
High tumor mutational burden
How did the identified genomic alterations affect treatment selection?
They identified multiple actionable targets to guide therapy
They confirmed eligibility for immunotherapy
They did not influence treatment decision-making
They required switching to PARP inhibitor therapy
What combination of findings most strongly supports pseudoprogression rather than true disease progression?
Increase in liver lesion size on CT alone
Stable tumor markers with worsening of symptoms
Significant decrease in ctDNA fraction with revised MRI interpretation
New metastatic lesions seen on bone scan
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