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-id,type,age,molecular_phenotype,treatment_status,special_considerations,description,ground_truth
-1,naive,65,ER+/PR+/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved","65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","Lumpectomy, radiation, endocrine therapy. No need for chemo."
-2,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved","41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","Lumpectomy, radiation, endocrine therapy with tamoxifen"
-3,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Large tumor (T3), no nodes involved","41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","Surgery followed by adjuvant chemotherapy (Taxotere and cyclophosphamide), radiation and then endocrine therapy."
-4,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Large tumor (T3), no nodes involved","41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.",Surgery followed by radiation and endocrine therapy. No role of chemotherapy here.
-5,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.",Surgery followed by radiation and adjuvant chemotherapy therapy. Then endocrine therapy.
-6,naive,56,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","Surgery and chemotherapy, radiation, then endocrine therapy."
-7,naive,56,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","Surgery, and endocrine therapy. No chemotherapy."
-8,naive,56,ER-/PR-/HER2+,Newly diagnosed,"Small tumor (T2), nodal involvement, no distant metastasis","56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","Neoadjuvant chemotherapy. TCHP 6 cycles. Surgery, radiation, targeted therapy with HP if she had PR, or TDM1 if had residual disease at time of surgery."
-9,naive,57,ER+/PR+/HER2+,Newly diagnosed,"Very small tumor (T1), no nodes involved, no distant metastasis","57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","Surgery first. Confirm disease. Neoadjuvant is only done for 2cm or greater tumors. Adjuvant taxol + Herceptin for 12 weeks, and Herceptin to continue for 9 more months per APT trial. Endocrine therapy as well."
-10,naive,42,ER-/PR-/HER2+,Newly diagnosed,"Inflammatory breast cancer, T4 disease affecting the chest wall, large tumor, N3 disease, bulky nodes, not metastatic","42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","Chemotherapy – TCHP for 6 cycles. If responds well, modified radical mastectomy with axillary lymph node dissection and removal of all the skin. Go for radiation and then adjuvant therapy which can either be HP or T-DM1 depending on residual disease."
-11,naive,35,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T2), no metastatic disease","35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","TCH for 6 cycles. No pertuzumab because no lymph node disease or T3 tumor. Surgery. Adjuvant targeted therapy would be TDM1 or Herceptin. Then, she will get endocrine therapy."
-12,naive,45,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T1), nodal involvement","45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","Treat neoadjuvant chemo with TCHP. Surgical resection, followed by radiation. Then, hormonal therapy and HP in the adjuvant setting if pathological CR achieved."
-13,naive,50,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T2), very high Ki-67, node negative, no metastasis","50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together."
-14,naive,50,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), very high Ki-67, node negative, no metastasis","50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","Surgery first. No role for neoadjuvant if < 2 cm. If truly has 7 mm on surgery, give TC chemo for 4 cycles. (Clinical trial data would support adjuvant AC -> T, per the ABC trial.)"
-15,naive,59,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T2), nodal involvement, no metastasis","59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together."
-16,naive,43,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T1), post-surgery, no nodes involved","43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","Does not qualify for immunotherapy. Radiation after surgery. -Adjuvant chemo with ddAC 4 cycles, followed by weekly taxol or every 3-week Taxotere."
-17,naive,45,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T1), nodal involvement","45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","Neoadjuvant chemo (TCHP x6), radiation after. Hormonal therapy and HP in adjuvant setting."
-18,naive,59,ER-/PR-/HER2+,Newly diagnosed,"Very small tumor (T1), elected for mastectomy, no nodes involved","59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.",No treatment necessary.
-19,naive,59,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved, post-mastectomy","59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.",No treatment necessary
-20,naive,42,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T1), no nodes involved","42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","Surgery first, then adjuvant chemo (AC -> T)"
-21,naive,65,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), no nodal involvement, invasive lobular","65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.",Lumpectomy. Radiation. Started on aromatase inhibitors.
-22,naive,48,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement with extra nodal extension","48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","Taxotere + cyclophosphamide chemotherapy, followed by radiation and endocrine therapy."
-23,naive,42,,,High risk surveillance,"42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","Surveillance every 6 months, alternating ultrasound + mammogram with breast MRI"
-24,naive,91,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), Geriatric oncology, no nodal involvement, post lumpectomy","91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","Complete radiation therapy. Then, exemestane."
-25,naive,55,ER+/PR-/HER2+,Newly diagnosed,"Large tumor (T2), nodal involvement on left side","55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","Neoadjuvant tx, HP + chemo, and then she had surgery, attained a pathological complete response. Adjuvant HP, radiation and tamoxifen."
-26,naive,65,,Newly diagnosed,"Satellite lesions, sentinel lymph nodes with isolated tumor cells","65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.",Radiation followed by endocrine therapy.
-27,naive,65,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), low Ki-67","65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","Upfront surgery. Depending on the pathology report, we will decide on chemotherapy or not."
-28,naive,33,,,High risk surveillance and chemoprevention,"33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.",Started on tamoxifen as chemo-prevention.
-29,naive,55,,Newly diagnosed,"Small tumor (T1), post lumpectomy, no nodal involvement","55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.",Adjuvant chemotherapy with TC x4.
-30,naive,39,ER+/PR-/HER2-,Newly diagnosed,"Very large tumor (T3) Satellite lesions, R-axillary LAD, residual disease, neoadjuvant therapy, lymph node micrometastasis and extra-nodal extension","39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","We would do radiation, followed by ovarian suppression plus aromatase inhibitor, plus verzinio and zometa."
-31,refractory,61,ER-/PR-/HER2-,"Recurrent disease, refractory to multiple lines of treatment","KEYNOTE-522 trial, residual disease, metastasis to the bone, multiple lines of treatment, declining performance status, further disease progression (End of life care)","61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","Compassionate care, hospice."
-32,refractory,75,ER-/PR-/HER2+,"Recurrent disease, refractory to multiple lines of treatment","Full course of treatment, multi-organ metastasis, brain radiation, progression in brain after radiation (End of life care)","75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","Compassionate care, hospice. Alternatively, she can get some benefit from CNS-active therapies such as fam-trastuzumab deruxtecan, or capecitabine/trastuzumab/tucatinib."
-33,refractory,50,ER+/PR+/HER2-,Upfront metastatic disease,"Axillary lymph node involvement, metastasis to bone and liver","50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.",Chemo (Docetaxel-HP per the CLEOPATRA trial) + dual anti-HER2 frontline.
-34,refractory,40,ER-/PR-/HER2-,Upfront metastatic disease,"L-axillary lymph node involvement, metastatic disease to liver, PDL1-positive","40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?",Chemo + immunotherapy.
-35,refractory,40,ER+/HER2+,Upfront metastatic disease,"R-axillary lymph node involvement, high Ki-67, metastatic liver disease","40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver",Chemo + dual anti-HER2 frontline
-36,refractory,40,ER+/HER2-,Upfront metastatic disease,"R-axillary lymph node involvement, metastatic liver disease","40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver",CDK4/6 + aromatase inhibitor and ovarian suppression.
-37,refractory,85,ER-/PR-/HER2-,Upfront metastatic disease,"Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 positive","85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","Single-agent gemcitabine, add Keytruda"
-38,refractory,85,ER-/PR-/HER2-,Upfront metastatic disease,"Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 negative","85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.",Single-agent gemcitabine
-39,refractory,38,ER+/PR+/HER2-,Recurrent disease after mastectomy,"Male breast cancer, post treatment recurrence in mastectomy bed, radiation treatment and recurrence again to the bone","38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.",Endocrine therapy + CDK 4/6 inhibitor.
-40,refractory,58,ER+/PR+/HER2-,Post-mastectomy,"Male breast cancer, obese patient, Small tumor (T2), nodal involvement, post-mastectomy","58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.",Endocrine therapy (Tamoxifen) and radiation. Can also consider adjuvant abemaciclib.
-41,refractory,61,ER+/PR+/HER2+,Recurrent disease,"Previously treated with lumpectomy + radiation, on hormone therapy, spinal and liver metastasis","61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.",Switch to fulvestrant
-42,refractory,65,ER+/PR+/HER2-,Progression of disease on therapy,"On treatment, new lesions noted in liver, ESR-1 mutation","65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","Change to faslodex and verzinio. Alternatively, test for PIK3CA mutation. Use alpelisib if positive."
-43,refractory,59,ER+/PR+/HER2-,Progression of disease on therapy,"On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung","59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.",Continue faslodex + Everolimus or Enhertu
-44,refractory,63,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","63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.",Change to elacestrant. Continue xgeva for bone disease.
-45,refractory,55,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","55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation.","Change to enhertu and xgeva, continue anastrazole"
-46,refractory,63,ER+/PR+/HER2-,Progression of disease on therapy,"Upfront metastasis with bone involvement, progressed on therapy, now with PIK3CA mutation","63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.",Change to Alpelisib and Fulvestrant. Continue Xgeva for bone disease
-47,refractory,49,ER-/PR-/HER2+,Recurrence of disease,"Finished treatment, no residual disease, new recurrence in brain","49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.",Radiation for brain metastasis and Enhertu for systemic therapy
-48,refractory,45,ER-/PR-/HER2-,Recurrence of disease,"Finished treatment with KEYNOTE-522 protocol, recurrence at mastectomy scar, no other sites of disease, recurrence is triple negative as well","45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.",Refer for surgical resection per CALOR
-49,refractory,53,ER-/PR-/HER2-,Progression of disease,"Treated with KEYNOTE-522, residual disease, got Xeloda, progression to liver and then bone","53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.",Change to Sacituzumab-govitecan vs Enhertu
-50,refractory,57,ER-/PR-/HER2+,Progression of disease,"Treated appropriately, bone metastasis, on Enhertu, had brain metastasis, continued progression of disease on treatment, brain biopsy showing HER2+ disease","57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","Change to tucatinib, trastuzumab and xeloda"
+id,type,age,molecular_phenotype,treatment_status,special_considerations,description,ground_truth,system_prompt,question_all,question_neoadjuvant,question_surgery,question_adjuvant,question_genetic,question_support
+1,naive,65,ER+/PR+/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved","65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","Lumpectomy, radiation, endocrine therapy. No need for chemo.","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: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%.","What psychosocial support and counseling would you recommend for this patient? Case: 65 year old woman. Post-menopausal. Grade 1, invasive ductal carcinoma (IDC). Strongly ER positive (8/8), PR positive (5/8) and HER2 negative (IHC of 0). Found to have a 8 mm tumor. No nodes involved. ECOG performance status of 0. Ki-67 of 18%."
+2,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved","41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","Lumpectomy, radiation, endocrine therapy with tamoxifen","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: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%.","What psychosocial support and counseling would you recommend for this patient? Case: 41 year old woman. Premenopausal. Grade 1 invasive ductal carcinoma (IDC). ER strongly positive (8/8), PR strongly positive (8/8), HER2 negative (IHC 0). 8 mm tumor. OncotypeDX returns with a score of 12. No nodes involved. ECOG performance status of 0. Ki-67 of 25%."
+3,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Large tumor (T3), no nodes involved","41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","Surgery followed by adjuvant chemotherapy (Taxotere and cyclophosphamide), radiation and then endocrine therapy.","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: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%.","What psychosocial support and counseling would you recommend for this patient? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 36. ECOG performance status of 0. Ki-67 of 34%."
+4,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Large tumor (T3), no nodes involved","41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.",Surgery followed by radiation and endocrine therapy. No role of chemotherapy here.,"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: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%.","What psychosocial support and counseling would you recommend for this patient? Case: 41 year old woman. Premenopausal. Grade 3 invasive ductal carcinoma (IDC). ER strongly positive (7/8), PR positive (5/8), and HER2 negative (IHC 0). 8.2 cm tumor. No nodes involved. OncotypeDX is run, score of 11. ECOG performance status of 0. Ki-67 of 30%."
+5,naive,41,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.",Surgery followed by radiation and adjuvant chemotherapy therapy. Then endocrine therapy.,"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: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24.","What psychosocial support and counseling would you recommend for this patient? Case: 41 year old woman, premenopausal. Grade 2 invasive ductal carcinoma (IDC), ER positive (8/8), PR positive (8/8) and HER2 negative (IHC of 0). 2.0 cm tumor. 1 lymph node positive out of 3 (3 total removed). OncotypeDX score of 24."
+6,naive,56,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","Surgery and chemotherapy, radiation, then endocrine therapy.","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: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34.","What psychosocial support and counseling would you recommend for this patient? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size is 1.7 cm, two positive lymph nodes out of 4. OncotypeDX score of 34."
+7,naive,56,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement","56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","Surgery, and endocrine therapy. No chemotherapy.","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: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13.","What psychosocial support and counseling would you recommend for this patient? Case: 56 year old woman, post-menopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative, HER2 negative (IHC of 0). Tumor size 1.7 cm, two positive lymph nodes out of 4. Oncotype 13."
+8,naive,56,ER-/PR-/HER2+,Newly diagnosed,"Small tumor (T2), nodal involvement, no distant metastasis","56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","Neoadjuvant chemotherapy. TCHP 6 cycles. Surgery, radiation, targeted therapy with HP if she had PR, or TDM1 if had residual disease at time of surgery.","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: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease.","What psychosocial support and counseling would you recommend for this patient? Case: 56 year old woman, postmenopausal. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 positive. Tumor size is 3 cm. Biopsy proven positive lymph nodes. No distant metastatic disease."
+9,naive,57,ER+/PR+/HER2+,Newly diagnosed,"Very small tumor (T1), no nodes involved, no distant metastasis","57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","Surgery first. Confirm disease. Neoadjuvant is only done for 2cm or greater tumors. Adjuvant taxol + Herceptin for 12 weeks, and Herceptin to continue for 9 more months per APT trial. Endocrine therapy as well.","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: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease.","What psychosocial support and counseling would you recommend for this patient? Case: 57 year old woman, postmenopausal. Grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive and HER2 positive. Tumor size is 8 mm, node negative. No distant metastatic disease."
+10,naive,42,ER-/PR-/HER2+,Newly diagnosed,"Inflammatory breast cancer, T4 disease affecting the chest wall, large tumor, N3 disease, bulky nodes, not metastatic","42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","Chemotherapy – TCHP for 6 cycles. If responds well, modified radical mastectomy with axillary lymph node dissection and removal of all the skin. Go for radiation and then adjuvant therapy which can either be HP or T-DM1 depending on residual 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: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic.","What psychosocial support and counseling would you recommend for this patient? Case: 42 year old woman. Premenopausal. Inflammatory breast cancer. Grade 3 invasive ductal carcinoma (IDC). ER negative, PR negative, HER2 positive. She has T4 disease (Affecting the chest wall and skin). Measures at 10 cm. N3 disease (supraclavicular disease) with bulky fixed lymph nodes. Not metastatic."
+11,naive,35,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T2), no metastatic disease","35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","TCH for 6 cycles. No pertuzumab because no lymph node disease or T3 tumor. Surgery. Adjuvant targeted therapy would be TDM1 or Herceptin. Then, she will get endocrine therapy.","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: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease.","What psychosocial support and counseling would you recommend for this patient? Case: 35 year old woman, grade 2 invasive ductal carcinoma (IDC). ER positive, PR positive, HER2 positive. Tumor size is 3 cm, node negative, no distant metastatic disease."
+12,naive,45,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T1), nodal involvement","45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","Treat neoadjuvant chemo with TCHP. Surgical resection, followed by radiation. Then, hormonal therapy and HP in the adjuvant setting if pathological CR achieved.","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: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes.","What psychosocial support and counseling would you recommend for this patient? Case: 45 year old woman, premenopausal. ER positive, PR positive, HER2 positive. Tumor size is 2 cm. Positive nodes."
+13,naive,50,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T2), very high Ki-67, node negative, no metastasis","50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together.","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: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease.","What psychosocial support and counseling would you recommend for this patient? Case: 50 year old woman. Pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 75%. Tumor size is 2.5 cm, node negative, no distant metastatic disease."
+14,naive,50,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), very high Ki-67, node negative, no metastasis","50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","Surgery first. No role for neoadjuvant if < 2 cm. If truly has 7 mm on surgery, give TC chemo for 4 cycles. (Clinical trial data would support adjuvant AC -> T, per the ABC trial.)","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: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease","What psychosocial support and counseling would you recommend for this patient? Case: 50 year old woman, pre-menopausal. Grade 3 invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 85%. Tumor size is 7mm. Node negative. No metastatic disease"
+15,naive,59,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T2), nodal involvement, no metastasis","59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","KEYNOTE 522 protocol: Neoadjuvant therapy with Pembro + AC, followed by pembro + taxol + carbo. Followed by surgery. If pathological response, just gets adjuvant pembro. Otherwise, Xeloda and pembro together.","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: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease.","What psychosocial support and counseling would you recommend for this patient? Case: 59 year old woman, post-menopausal, grade 2 triple negative breast cancer (ER negative, PR negative and HER2 negative). Ki-67 45%. 3-cm tumor size. Biopsy proven lymph nodes, no metastatic disease."
+16,naive,43,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T1), post-surgery, no nodes involved","43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","Does not qualify for immunotherapy. Radiation after surgery. -Adjuvant chemo with ddAC 4 cycles, followed by weekly taxol or every 3-week Taxotere.","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: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease.","What psychosocial support and counseling would you recommend for this patient? Case: 43 year old woman, premenopausal. Already had surgery, 1.2 cm tumor, no nodes involved. Triple negative (ER negative, PR negative and HER2 negative) disease."
+17,naive,45,ER+/PR+/HER2+,Newly diagnosed,"Small tumor (T1), nodal involvement","45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","Neoadjuvant chemo (TCHP x6), radiation after. Hormonal therapy and HP in adjuvant setting.","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: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes.","What psychosocial support and counseling would you recommend for this patient? Case: 45 year old woman, premenopausal, ER positive, PR positive, HER2 positive. 2 cm in size of tumor. She has positive lymph nodes."
+18,naive,59,ER-/PR-/HER2+,Newly diagnosed,"Very small tumor (T1), elected for mastectomy, no nodes involved","59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.",No treatment necessary.,"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: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy.","What psychosocial support and counseling would you recommend for this patient? Case: 59-year old woman goes to surgery first. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 positive. No nodes positive. She had elected for mastectomy."
+19,naive,59,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), no nodes involved, post-mastectomy","59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.",No treatment necessary,"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: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy.","What psychosocial support and counseling would you recommend for this patient? Case: 59-year old woman goes to surgery. 2-mm grade 2 invasive ductal carcinoma (IDC), ER negative, PR negative, HER2 negative. No nodes positive. Had mastectomy."
+20,naive,42,ER-/PR-/HER2-,Newly diagnosed,"Small tumor (T1), no nodes involved","42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","Surgery first, then adjuvant chemo (AC -> T)","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: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative.","What psychosocial support and counseling would you recommend for this patient? Case: 42 year old woman, premenopausal, grade 3 invasive ductal carcinoma (IDC). Tumor size is 1.5 cm and Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Nodes negative."
+21,naive,65,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), no nodal involvement, invasive lobular","65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.",Lumpectomy. Radiation. Started on aromatase inhibitors.,"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: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive.","What psychosocial support and counseling would you recommend for this patient? Case: 65 year old woman, postmenopausal. 1.2 cm invasive lobular cancer. ER positive, PR positive, HER2 negative. 0/3 nodes are positive."
+22,naive,48,ER+/PR+/HER2-,Newly diagnosed,"Small tumor (T1), nodal involvement with extra nodal extension","48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","Taxotere + cyclophosphamide chemotherapy, followed by radiation and endocrine therapy.","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: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk.","What psychosocial support and counseling would you recommend for this patient? Case: 48 years old woman. 1.7 cm grade 1 invasive ductal carcinoma (IDC). Premenopausal. ER positive (> 90%), PR positive (> 90%), HER2 negative. Ki-67 of 7%, had 2/7 nodes positive, with extra nodal extension. MammaPrint came back as low risk."
+23,naive,42,,,High risk surveillance,"42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","Surveillance every 6 months, alternating ultrasound + mammogram with breast MRI","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: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy.","What psychosocial support and counseling would you recommend for this patient? Case: 42 year old woman. No personal history of breast cancer. Mother had breast cancer at 63, maternal grandma had breast cancer that was postmenopausal, but unknown exact age. Maternal aunt had esophageal cancer 60. Maternal uncle had prostate cancer. Maternal cousin with testicular cancer in his 20s. Genetic testing was negative for our patient. Due to family history, we're seeing her. Pre-menopausal. Menarche at 12. G2P2, first child at 27. Breast feeding for 1 yr. Oral contraceptives from age 16 to 40. No previous breast biopsy."
+24,naive,91,ER+/PR-/HER2-,Newly diagnosed,"Small tumor (T1), Geriatric oncology, no nodal involvement, post lumpectomy","91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","Complete radiation therapy. Then, exemestane.","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: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive.","What psychosocial support and counseling would you recommend for this patient? Case: 91-year old woman. Had a lumpectomy for a 2.5 cm, grade 3 invasive ductal carcinoma (IDC). ER positive (90%), PR 1%, HER2 neg. Ki-67 of 72%. No lymph nodes positive."
+25,naive,55,ER+/PR-/HER2+,Newly diagnosed,"Large tumor (T2), nodal involvement on left side","55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","Neoadjuvant tx, HP + chemo, and then she had surgery, attained a pathological complete response. Adjuvant HP, radiation and tamoxifen.","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 had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive.","What psychosocial support and counseling would you recommend for this patient? Case: 55 year old woman had 4.4 cm left breast mass and a left axillary LN on diagnosis. Had a biopsy of the breast mass and the LN were positive for grade 3 invasive ductal carcinoma (IDC). ER positive (8/8), PR negative (0/8) and HER2 positive."
+26,naive,65,,Newly diagnosed,"Satellite lesions, sentinel lymph nodes with isolated tumor cells","65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.",Radiation followed by endocrine therapy.,"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: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk.","What psychosocial support and counseling would you recommend for this patient? Case: 65 year old woman, went for lumpectomy. Four foci of grade 1 invasive ductal carcinoma (IDC): 1.3 cm, 1.1 cm, 5 mm, 4 mm. 1 out of 2 sentinel lymph node biopsy (SLN) with isolated tumor cells. OncotypeDx score of 12, low-risk."
+27,naive,65,ER-/PR-/HER2-,Newly diagnosed,"Very small tumor (T1), low Ki-67","65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","Upfront surgery. Depending on the pathology report, we will decide on chemotherapy or not.","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: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%.","What psychosocial support and counseling would you recommend for this patient? Case: 65 year old woman. 8-mm right breast cancer. Grade 2 invasive ductal carcinoma (IDC). Triple negative (ER negative, PR negative and HER2 negative) breast cancer. Ki67 of 20%."
+28,naive,33,,,High risk surveillance and chemoprevention,"33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.",Started on tamoxifen as chemo-prevention.,"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: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS.","What psychosocial support and counseling would you recommend for this patient? Case: 33 year old woman, she has a family history of paternal grandfather with prostate cancer and kidney cancer. She has had multiple biopsies on the left: One was benign, showed ductal hyperplasia and pseudoangiomatous stromal hyperplasia. Next biopsy showed Lobular carcinoma in situ (LCIS) and sclerosing papilloma and atypical lobular hyperplasia (ALH). Genetic testing was negative. Another biopsy, showed ALH and LCIS as well as radial scar on the left side. She finally had an excisional biopsy where they removed complex sclerosing lesions and 1-mm LCIS."
+29,naive,55,,Newly diagnosed,"Small tumor (T1), post lumpectomy, no nodal involvement","55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.",Adjuvant chemotherapy with TC x4.,"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, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29.","What psychosocial support and counseling would you recommend for this patient? Case: 55 year old woman, went for a right lumpectomy for a 2.7 cm grade 1 invasive ductal carcinoma (IDC). No lymph nodes. OncotypeDX score of 29."
+30,naive,39,ER+/PR-/HER2-,Newly diagnosed,"Very large tumor (T3) Satellite lesions, R-axillary LAD, residual disease, neoadjuvant therapy, lymph node micrometastasis and extra-nodal extension","39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","We would do radiation, followed by ovarian suppression plus aromatase inhibitor, plus verzinio and zometa.","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: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension.","What psychosocial support and counseling would you recommend for this patient? Case: 39 year old woman, premenopausal. Had a right breast mass. At least 4 masses, the total span was 15 cm. Had right axillary lymphadenopathy. Biopsy of the masses and lymph node showed grade 2 invasive ductal carcinoma (IDC). ER positive (95%) PR 7%, HER2 negative. Received neoadjuvant AC for 4 cycles, weekly taxol for 12 cycles. Had surgery, and ended up having 2 residual foci of grade 3 invasive ductal carcinoma (IDC) of 2 mm and 1.3 mm. Had 13.5 cm of ductal carcinoma in-situ (DCIS). 2/13 lymph nodes had micromets including extranodal extension."
+31,refractory,61,ER-/PR-/HER2-,"Recurrent disease, refractory to multiple lines of treatment","KEYNOTE-522 trial, residual disease, metastasis to the bone, multiple lines of treatment, declining performance status, further disease progression (End of life care)","61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","Compassionate care, hospice.","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: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?","What psychosocial support and counseling would you recommend for this patient? Case: 61 year old woman, post-menopausal. Triple negative breast cancer (ER negative, PR negative, HER-2 negative). Treated with neoadjuvant KEYNOTE-522, mastectomy, Xeloda for residual disease, unfortunately developed metastatic disease to bone. Went on to receive 5 additional lines of chemotherapy. Progression of disease noted. Performance status declining. ECOG 3. What to do now?"
+32,refractory,75,ER-/PR-/HER2+,"Recurrent disease, refractory to multiple lines of treatment","Full course of treatment, multi-organ metastasis, brain radiation, progression in brain after radiation (End of life care)","75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","Compassionate care, hospice. Alternatively, she can get some benefit from CNS-active therapies such as fam-trastuzumab deruxtecan, or capecitabine/trastuzumab/tucatinib.","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: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis.","What psychosocial support and counseling would you recommend for this patient? Case: 75 year old woman, post-menopausal. Stage III HER-2 positive breast cancer. Treated with neoadjuvant + surgery + rads. Adjuvant anti-HER2 therapy for 1 year. Developed metastasis to liver, bones, lung and brain. Radiation to the first brain metastasis, systemic therapy with TDM1, and had control of disease for 1 year. Developed new onset seizures. More brain metastasis."
+33,refractory,50,ER+/PR+/HER2-,Upfront metastatic disease,"Axillary lymph node involvement, metastasis to bone and liver","50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.",Chemo (Docetaxel-HP per the CLEOPATRA trial) + dual anti-HER2 frontline.,"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: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver.","What psychosocial support and counseling would you recommend for this patient? Case: 50 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymph node in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki67 of 50%. Staging CT and bone scan show metastatic disease in bone and liver."
+34,refractory,40,ER-/PR-/HER2-,Upfront metastatic disease,"L-axillary lymph node involvement, metastatic disease to liver, PDL1-positive","40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?",Chemo + immunotherapy.,"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: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?","What psychosocial support and counseling would you recommend for this patient? Case: 40 year old woman, pre-menopausal. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). ER negative, PR negative and HER2 negative. High Ki-67, 60%. Staging scans metastatic disease to liver. PDL1 positive. CPS of 12%, next line of treatment?"
+35,refractory,40,ER+/HER2+,Upfront metastatic disease,"R-axillary lymph node involvement, high Ki-67, metastatic liver disease","40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver",Chemo + dual anti-HER2 frontline,"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: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver","What psychosocial support and counseling would you recommend for this patient? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 positive, Ki-67 of 60%. Staging CT and bone scan show metastatic disease in liver"
+36,refractory,40,ER+/HER2-,Upfront metastatic disease,"R-axillary lymph node involvement, metastatic liver disease","40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver",CDK4/6 + aromatase inhibitor and ovarian suppression.,"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: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver","What psychosocial support and counseling would you recommend for this patient? Case: 40 year old woman, pre-menopausal. Noted to have right palpable breast mass and lymphadenopathy in axilla. Core biopsy: Grade III invasive ductal carcinoma (IDC), ER positive, HER2 negative Ki-67 of 40%. Staging CT and bone scan show metastatic disease in liver"
+37,refractory,85,ER-/PR-/HER2-,Upfront metastatic disease,"Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 positive","85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","Single-agent gemcitabine, add Keytruda","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: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%","What psychosocial support and counseling would you recommend for this patient? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. LN left axillary. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 positive. CPS of 40%"
+38,refractory,85,ER-/PR-/HER2-,Upfront metastatic disease,"Cardiac comorbidities, geriatric oncology, left axillary involvement, metastatic lung and liver disease, PDL1 negative","85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.",Single-agent gemcitabine,"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: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%.","What psychosocial support and counseling would you recommend for this patient? Case: 85 year old woman, post-menopausal, DM, A-fib, HF. Left palpable breast mass. Left axillary lymphadenopathy. Imaging and core biopsy came back with grade III invasive ductal carcinoma (IDC). Triple negative breast cancer (ER negative, PR negative, HER-2 negative). High Ki-67, 50%. Staging scans metastatic disease to liver and lungs, bones. PDL1 negative. CPS of 0%."
+39,refractory,38,ER+/PR+/HER2-,Recurrent disease after mastectomy,"Male breast cancer, post treatment recurrence in mastectomy bed, radiation treatment and recurrence again to the bone","38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.",Endocrine therapy + CDK 4/6 inhibitor.,"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: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones.","What psychosocial support and counseling would you recommend for this patient? Case: 38 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC). ER and PR positive, HER2 negative. Ki-67 20%. Received neoadjuvant chemo. Mastectomy, had sentinel lymph node (SLN) biopsy. Residual carcinoma. Had radiation post-mastectomy. Had recurrence in mastectomy bed. Staging shows metastasis to bones."
+40,refractory,58,ER+/PR+/HER2-,Post-mastectomy,"Male breast cancer, obese patient, Small tumor (T2), nodal involvement, post-mastectomy","58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.",Endocrine therapy (Tamoxifen) and radiation. Can also consider adjuvant abemaciclib.,"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: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer.","What psychosocial support and counseling would you recommend for this patient? Case: 58 year old male, obese. Presented with R-sided breast mass. Underwent imaging, biopsy shows grade II invasive ductal carcinoma (IDC), ER and PR positive, HER2 negative. Ki-67 20%. 3 cm tumor. 3 nodes positive. Neoadjuvant chemo. Mastectomy, SLN biopsy positive. No residual cancer."
+41,refractory,61,ER+/PR+/HER2+,Recurrent disease,"Previously treated with lumpectomy + radiation, on hormone therapy, spinal and liver metastasis","61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.",Switch to fulvestrant,"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: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression.","What psychosocial support and counseling would you recommend for this patient? Case: 61 year old, post-menopausal female with prior history of ER positive, PR positive, HER-2 negative, node negative, involving right breast s/p lumpectomy. Got radiation four years ago, and taking anastrazole. Presenting to the ER with mid back pain, CT chest/abdomen/pelvis and MRI spine show metastatic disease with three lesions in liver, and widespread bone metastasis. No signs of cord compression."
+42,refractory,65,ER+/PR+/HER2-,Progression of disease on therapy,"On treatment, new lesions noted in liver, ESR-1 mutation","65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","Change to faslodex and verzinio. Alternatively, test for PIK3CA mutation. Use alpelisib if positive.","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: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation.","What psychosocial support and counseling would you recommend for this patient? Case: 65 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement, is currently receiving anastrazole and verzinio. Repeat staging scans show new liver metastasis. NGS shows ESR-1 mutation."
+43,refractory,59,ER+/PR+/HER2-,Progression of disease on therapy,"On ribociclib, ESR-1 mutation, metastasis to bone and liver, changed therapy and now metastasis to lung","59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.",Continue faslodex + Everolimus or Enhertu,"You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).","Your reply should be structured in the following format:
+
+Case summary: Summarize the salient features of the case
+
+Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used.
+
+Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for?
+
+Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen.
+
+Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family?
+
+Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways.
+
+Case text: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion.","What psychosocial support and counseling would you recommend for this patient? Case: 59 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone and liver involvement. Had POD on anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. Now presenting with new symptomatic malignant pleural effusion."
+44,refractory,63,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","63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.",Change to elacestrant. Continue xgeva for bone disease.,"You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).","Your reply should be structured in the following format:
+
+Case summary: Summarize the salient features of the case
+
+Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used.
+
+Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for?
+
+Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen.
+
+Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family?
+
+Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways.
+
+Case text: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules.","What psychosocial support and counseling would you recommend for this patient? Case: 63 year old, post-menopausal female with history of metastatic hormone positive (ER positive, PR positive, HER2 negative) breast cancer with bone involvement. Had progression of disease (POD) on first line anastrazole and ribociclib. Next generation sequencing (NGS) shows ESR-1 mutation. She was changed to fulvestrant and ribociclib. POD with new liver metastasis and possible biliary obstruction. She was switched to xeloda and faslodex. Now presenting with new pulmonary nodules."
+45,refractory,55,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","55 year old woman, post menopausal, with history of prior hormone positive (ER positive, PR positive), HER2 negative right breast cancer. Stage II on presentation with 3-4 nodes positive. Received right mastectomy and radiation. OncotypeDX score 29 and received adjuvant chemotherapy. Received verzinio and anastrazole for two years, continuing latter. Now presents with new bone and liver metastasis. Biopsy shows hormone positive, HER2 negative (IHC 1+, but FISH negative). NGS without PIK3CA or ESR-1 mutation.","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."
+46,refractory,63,ER+/PR+/HER2-,Progression of disease on therapy,"Upfront metastasis with bone involvement, progressed on therapy, now with PIK3CA mutation","63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.",Change to Alpelisib and Fulvestrant. Continue Xgeva for bone disease,"You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).","Your reply should be structured in the following format:
+
+Case summary: Summarize the salient features of the case
+
+Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used.
+
+Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for?
+
+Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen.
+
+Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family?
+
+Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways.
+
+Case text: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation.","What psychosocial support and counseling would you recommend for this patient? Case: 63 year old, post-menopausal female with history of metastatic hormone positive breast cancer with bone involvement. Had progression of disease on first line anastrazole and ribociclib. NGS shows PIK3CA mutation."
+47,refractory,49,ER-/PR-/HER2+,Recurrence of disease,"Finished treatment, no residual disease, new recurrence in brain","49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.",Radiation for brain metastasis and Enhertu for systemic therapy,"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: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis.","What psychosocial support and counseling would you recommend for this patient? Case: 49 year old female with history of HER2 positive, hormone negative (ER negative, PR negative) left breast cancer status post TCHP, lumpectomy, radiation therapy with no residual disease and adjuvant HP completed one year ago. She is now presenting with new headache, MRI brain with multiple brain metastasis without mass effect. CT chest/abdomen/pelvis shows new liver metastasis."
+48,refractory,45,ER-/PR-/HER2-,Recurrence of disease,"Finished treatment with KEYNOTE-522 protocol, recurrence at mastectomy scar, no other sites of disease, recurrence is triple negative as well","45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.",Refer for surgical resection per CALOR,"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: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease.","What psychosocial support and counseling would you recommend for this patient? Case: 45 year old woman with triple negative breast cancer (ER negative, PR negative, HER-2 negative) of left breast treated per KEYNOTE-522, left mastectomy and sentinel lymph node biopsy shows no residual disease and has completed adjuvant pembro. Now presenting with new nodules on left mastectomy scar, biopsy consistent recurrent triple negative breast cancer (ER negative, PR negative, HER-2 negative). No other sites of disease."
+49,refractory,53,ER-/PR-/HER2-,Progression of disease,"Treated with KEYNOTE-522, residual disease, got Xeloda, progression to liver and then bone","53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.",Change to Sacituzumab-govitecan vs Enhertu,"You are a helpful medical assistant, and I am a breast cancer specialist using this tool to help me evaluate a breast cancer case. Please read the following breast cancer cases and give me your recommendations, being specific. Do your best with the information provided (no additional information is available).","Your reply should be structured in the following format:
+
+Case summary: Summarize the salient features of the case
+
+Neoadjuvant therapy: Is neoadjuvant therapy indicated? If yes, what neoadjuvant therapy should be used.
+
+Surgery: Is surgery indicated here? Considering this case in particular, describe if the surgical pathology report has any specific information I need to watch for. If yes, what information do I need to look for?
+
+Adjuvant therapy: After surgery, what therapy should be initiated? (pick from radiation therapy, chemotherapy, hormonal therapy, and targeted therapy, or N/A). Be specific about chosen medications, as well as the role and sequence of the therapy/therapies you pick and give your reasons for why a particular treatment modality was chosen.
+
+Genetic testing: Per NCCN guidelines, does this patient meet criteria for genetic testing? What about their family?
+
+Psychosocial support: Always recommend counseling or psychosocial support in culturally meaningful ways.
+
+Case text: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2.","What psychosocial support and counseling would you recommend for this patient? Case: 53 year old woman with history of right sided triple negative breast cancer (ER negative, PR negative, HER-2 negative), treated per KEYNOTE-522, mastectomy showed 2cm focus of residual disease, hormone negative (ER negative, PR negative), HER-2 1+. Germline testing negative for BRCA. She received adjuvant eloda and pembrolizumab. Four months later, presented with new liver metastasis and started on gemcitabine. Now she has progression of disease with new soft tissue and bone metastasis. ECOG 2."
+50,refractory,57,ER-/PR-/HER2+,Progression of disease,"Treated appropriately, bone metastasis, on Enhertu, had brain metastasis, continued progression of disease on treatment, brain biopsy showing HER2+ disease","57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","Change to tucatinib, trastuzumab and xeloda","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: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","For this case, is neoadjuvant therapy indicated? If yes, what specific neoadjuvant therapy should be used? Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","For this case, what surgical approach is indicated? What specific pathology findings should I watch for? Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","After surgery, what adjuvant therapy should be initiated for this case? Be specific about medications and sequence. Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","Based on NCCN guidelines, does this patient meet criteria for genetic testing? What about their family? Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer.","What psychosocial support and counseling would you recommend for this patient? Case: 57 year old post menopausal female with history of HER2 positive breast cancer, progression of disease with bone metastasis one year after TCHP, lumpectomy and radiation. She was started on Enhertu. Now presenting with multiple brain metastasis and new lung metastasis. ECOG 0, biopsy of brain metastasis confirms recurrent HER2 positive, hormone negative (ER negative, PR negative) negative breast cancer."