--- a
+++ b/processing/MACCROBAT/26530965.txt
@@ -0,0 +1,15 @@
+A 42-year-old woman presented with a right breast lump, lower back pain, loss of height, marked kyphosis and hepatomegaly.
+Core biopsies from the breast lump showed ductal carcinoma in situ (sample labelled P1.1; Supplementary Fig.1 and Supplementary Table 1).
+An additional biopsy from an ipsilateral axillary lymph node (P1.2) revealed metastatic ductal adenocarcinoma (ER+ (8/8) and HER2+ (3+)).
+Computed tomography scan revealed widespread metastatic disease in bones, pleura and liver (Supplementary Fig.2 and Supplementary Table 2).
+The patient was started on treatment with trastuzumab and taxane-based chemotherapy, with a significant partial response (Supplementary Fig.3).
+After induction chemotherapy, she was maintained on tamoxifen and trastuzumab.
+After 19 months on treatment, she presented with seizures and head computed tomography revealed a large metastasis in the left frontal lobe (Supplementary Fig.4), which was resected (M2.1).
+Therapy with tamoxifen and trastuzumab was continued and collection of plasma samples was initiated (samples T1–T9).
+Four months after surgery, she had enlarging liver lesions and a new metastatic deposit in the left ovary (Supplementary Fig.5).
+Treatment was switched to a combination of lapatinib and capecitabine, resulting in stable disease for 12 months (Supplementary Fig.6).
+General deterioration then occurred, with disease progression in the chest (new pulmonary nodules, bilateral pleural effusions and posterior chest wall mass, Supplementary Fig.7; Eastern Cooperative Oncology Group performance status 2–3).
+Treatment was stopped and the patient died ∼4 months later.
+Tumour samples were obtained at diagnosis from the primary breast site (P1.1) and an axillary lymph node (P1.2); after 19 months from the brain metastasis area (M2.1); and at autopsy after 3 years on treatment (from the primary breast site, and from metastatic deposits in the chest, liver, ovary and vertebrae, labelled P3.1 and M3.1–M3.4, respectively).
+Serial plasma samples were obtained over the last 500 days of clinical follow-up (T1–T9).
+Tumour and plasma samples collected and the clinical course are summarized in Fig.1a,b.