Shirley Cheng, Edward Nguyen, and Jami Fukui
Applications of liquid biopsy are primarily to monitor treatment response and to detect secondary treatment resistant mutations. In patients with bone-dominant metastatic breast cancer it can be challenging to evaluate for new mutations. Here, we present two patient cases with bone-dominant hormone positive metastatic breast cancer in whom we utilized liquid biopsy testing to guide therapy upon disease progression. Liquid biopsies were used to evaluate circulating-tumor DNA and analyzed for mutations using next generation sequencing. PIK3CA mutations were identified in both cases allowing the use of FDA approved PIK3CA-directed treatment with alpelisib. These cases demonstrate the clinical use of liquid biopsy in identifying actionable mutations, offering patients targeted treatment options without undergoing a metastatic biopsy. More real world reports are needed to further understand current liquid biopsy utilization in oncology patient care.