37. A patient with ER⁺/PR⁺ breast cancer was cured with a drug ‘T’ whereas a second patient, did not respond to ‘T’. Which one of the following is the best therapy that you should suggest for the second patient?
    (1) Surgery, followed by HER-2/neu targeted drug
    (2) A drug that target triple negative (ER^– PR^– HER-2^–) breast cancer
    (3) Radiation, followed by drug ‘T’
    (4) Surgery, followed by radiation only.

Based on the web search results, the best therapeutic approach for the second patient, who has ER+/PR+ breast cancer and did not respond to drug ‘T,’ would be:

(2) A drug that targets triple-negative (ER- PR- HER-2-) breast cancer

Explanation

• Since the patient has ER+/PR+ breast cancer, but the second patient did not respond to drug ‘T’ (which likely targets ER/PR), a different regimen is needed.

• The most effective treatment for hormone receptor-positive breast cancer typically involves hormone therapy or targeted therapies specific to ER and PR.

• However, if the tumor is resistant to hormone therapy, alternative options include targeted therapy or chemotherapy tailored to the tumor’s molecular profile, including considering options in triple-negative breast cancer (TNBC) if the tumor’s receptor status is changed or re-evaluated.

• Moreover, for receptor-negative breast cancers, treatments like PARP inhibitors or immunotherapy are options, especially if there’s a BRCA mutation or PD-L1 positivity.

Additional Insight

• The search results emphasize that triple-negative breast cancer (TNBC) is more aggressive and less receptive to hormone or HER2-targeted therapies but responds better to chemotherapy and immunotherapy (e.g., pembrolizumab).

• The reference from the American Cancer Society indicates that in cases where tumor receptors are not expressed (ER, PR, HER2), systemic therapies like chemotherapy and immunotherapy are main options.