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MEDICAL ONCOLOGY PROGRESS NOTE **Date of Visit:** October 6, 2025 **Patient Name:** [Patient Name] **MRN:** 123456789 **DOB:** 03/15/1958 (Age: 67 years) **Date of Diagnosis:** January 12, 2023 --- ## CHIEF COMPLAINT Follow-up visit for metastatic breast cancer with declining functional status and liver metastases --- ## HISTORY OF PRESENT ILLNESS 67-year-old female with metastatic ER+/PR+/HER2-negative breast cancer, initially diagnosed with Stage IIA (T2N0M0) right breast invasive ductal carcinoma in January 2023. She completed lumpectomy, adjuvant chemotherapy (dose-dense AC-T), and radiation therapy, followed by adjuvant endocrine therapy with letrozole. Unfortunately, she developed metastatic disease to the liver in August 2024 (18 months from initial diagnosis, 6 months after completing adjuvant therapy). Biopsy-confirmed ER+ (95%), PR+ (80%), HER2-negative (IHC 1+). She was started on first-line endocrine therapy with fulvestrant + palbociclib. Recent imaging shows progression of liver metastases with new lesions. Patient reports increased fatigue, decreased appetite, and functional decline over the past 6 weeks. She has had dose reductions of palbociclib due to cytopenias and now presents with ECOG PS decline from 1 to 2. **Prior Systemic Therapy:** - Adjuvant: AC-T (completed May 2023) - Adjuvant endocrine: Letrozole (May 2023 - July 2024) - First-line metastatic: Fulvestrant + Palbociclib (August 2024 - October 2025) - Best response: Stable disease (4 months) - Discontinued due to disease progression