Patient #4 (ER + /HER2-) was followed for 15 years, including her primary tumor ductal carcinoma in situ (DCIS) and recurrent pleural effusions, including the following treatments: (1) doxorubicin with cyclophosphamide (“AC”; Fig. 2d), (2) anti-estrogens tamoxifen and letrozole, with capecitabine between, (3) cisplatin followed by fulvestrant, interferon treatment for a non-cancer diagnosis, carboplatin, then tamoxifen (“Platinum/anti-ER”), and (4) paclitaxel followed by olaparib (“Tax/olaparib”; Fig. 2d, Supplementary Data 4). This evidence concerns the gene ESR1 and neoplasm.