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After completing this case study, the reader should be able to:

  • Design a pharmacotherapeutic plan for treatment of locally advanced breast cancer.

  • Develop an appropriate monitoring plan for patients receiving adjuvant hormonal therapy for treatment of breast cancer.

  • Describe appropriate follow-up for patients after definitive treatment of breast cancer.

  • Provide patient education on the proper dosing, administration, and adverse effects of letrozole and palbociclib.

  • Compare and contrast the goals of treatment for locally advanced breast cancer versus metastatic breast cancer.


Chief Complaint

“I have a lump in my breast.”


Rosalita Garza is a 61-year-old woman presenting for evaluation of a new mass in her left breast. She first noticed a palpable breast mass on self-examination approximately 14 months ago but was unable to have this further investigated due to loss of health insurance. The patient describes the mass as intermittently painful. A mammogram was performed prior to her current visit, which was suspicious for malignancy.


  • Musculoskeletal injury in 2012. Fell from a chair while at work and suffered injuries to her cervical spine. She has required bone grafting from her right hip to her cervical spine. She is taking multiple medications for pain control.

  • Depression (diagnosed 7 years ago).


Sister diagnosed with breast cancer at age 60, now 5 years postsurgery. The patient was unable to recall any further details. No other significant cancer history is noted.


Lives with and acts as primary caretaker for her mother, who has dementia. Denies alcohol use and is a nonsmoker. Has a 35-year-old daughter who also lives with her.

Endocrine History

Menarche age 13; menopause age 55; first child age 26; G1P1A0. Last Pap smear at age 40. Took Premarin as HRT for 5 years after the onset of menopause.


  • Protonix 40 mg PO once daily

  • Zoloft 50 mg PO once daily

  • Ambien CR 12.5 mg PO at bedtime PRN sleep

  • Neurontin 300 mg PO TID

  • Hydrocodone/acetaminophen 5 mg/300 mg, one to two tablets PO Q 6 H PRN pain




Negative except for complaints noted above

Physical Examination


WDWN 61-year-old Hispanic female. Awake, alert, in NAD.


BP 127/71 mm Hg, P 89 ...

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