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What is your strategy for a patient who develops an enlarging ipsilateral axillary lymph node shortly after undergoing mastectomy and ALND for a pT2N3 ER+/HER2+ right breast cancer?

This patient underwent mastectomy and ALND (10/28 positive lymph nodes). Immediately following axillary LN dissection (and prior to radiation) imaging...

What would you recommend as the next line treatment in a post-menopausal woman with hormone receptor positive, HER2 positive breast cancer, with progression on T-DM1 in combination with aromatase inhibitor?

Does ER+ status impact your choice of neoadjuvant systemic therapy in premenopausal women with cT2N0 HER2+ breast cancer?

How would your treatment change given pCR rates are reportedly much lower in triple positive patients?

Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?

In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?

How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?

Would you recommend additional cytotoxic chemotherapy and/or switch her anti-Her therapy to T-DM1?

4 Answers available

How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?

How would this change if the patient had metastatic HR+,HER2- breast cancer and now has symptomatic pancytopenia secondary to BM involvement after TCH...

5 Answers available

Would you consider adding neoadjuvant endocrine therapy in a patient with HR+, HER2- breast cancer who has not clinically responded to neoadjuvant chemotherapy?

She has received 4 cycles of AC with no clinical response and is now pending completion with Taxol.

Would you choose neoadjuvant endocrine therapy for a low grade, node negative, ER/PR positive, breast cancer given delays in definitive surgery due to the COVID-19 pandemic?

Would your choice vary based on the patient's gender?

How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?

Would you consider delaying chemotherapy and proceeding only with endocrine for now?

How would you treat an elderly female with metastatic HR+,HER2- breast cancer on endocrine therapy who now has progressive bone only disease?

Initially treated with anastrozole, current treatment is with fulvestrant.

How would you approach a premenopausal woman with HR+, HER2- metastatic breast and a PIK3CA mutation?

How would you treat a patient with locally advanced HR+ breast cancer with contralateral axillary lymph node involvement?

No primary identified in the contralateral breast. No distant metastasis identified.

How would you treat a patient with HR+,HER2- metastatic breast cancer with a gBRCA mutation who has progressed on endocrine therapy with a new pericardial effusion?

How do you approach a pre-menopausal female with HR+ breast cancer with discordant IHC and OncotypeDx ER expression?

IHC: ER 70%; PR 70% OncotypeDx: ER - Negative; PR - Positive

How would you approach a patient with T3 HR+,HER2- breast cancer who had no clinical improvement after ddAC?

Do you proceed with Paclitaxel or go to surgery instead?

How do you approach recurrent, localized HR+, HER2- breast cancer in a patient who has progressed on exemestane (and previously on letrozole and tamoxifen)?

Would you use a NTRK TKI for a patient with metastatic HR+, HER2- breast cancer with a complex NTRK3 gene re-arrangement on Foundation testing?

ie, not a classic NTRK3-ETV6 fusion.The patient has progressed through CDk4/6 inhibitors and intolerant of alpelisib, and does not want chemotherapy.&...

Do you change systemic endocrine therapy for a patient who progresses only in the brain after SRS for metastatic HR+ breast cancer?

She has no other site of disease progression and has been on an aromatase inhibitor (progressed in the CNS while on a study with adjuvant abemaciclib)...

How would you approach adjuvant therapy for a premenopausal female with HR+, HER2+ breast cancer with N1mic disease?

Stage T1bN1mic

Would you offer neoadjuvant immunotherapy in addition to chemotherapy for locally advanced HR+ breast cancer based on the I-SPY 2 data?

How would you approach a postmenopausal female with localized ER+ breast cancer on adjuvant anastrozole with a rising estradiol level?

Pre-treatment estradiol: <5 Estradiol after 1 yr: 35

Would you recommend extended adjuvant endocrine therapy if a patient tolerated 5 years thus far but Breast Cancer Index (BCI) shows a high risk of recurrence with low likelihood of benefit from extended therapy?

6 Answers available

Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of ONJ?

Would you use neoadjuvant CDK4/6 inhibitor and AI in HR+ breast cancer based upon the randomized phase II CORALLEEN trial?

https://www.ncbi.nlm.nih.gov/pubmed/31838010

In a patient with early stage HR+ breast cancer who was perimenopausal at diagnosis but intolerant of AI, would you consider extending tamoxifen beyond 10 years?

In the absence of side effects, would you be inclined to continue beyond 10 years as chemoprevention? Would you factor an intermediate/high oncotype R...

What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?

Data presented at the 2017 SABCS (abstract GS1-01) of the EBCTCG meta-analysis stating a benefit of dose-dense chemotherapy applies to ER positive and...

What do you recommend for women on AI therapy who experience excessive hair loss?

How would you treat a postmenopausal woman with recurrent, localized ER+,HER2- breast cancer to the contralateral breast while on AI?

4 Answers available

In a patient with HR+HER2+ early breast cancer who is receiving adjuvant T-DM1 for residual disease, do you overlap endocrine therapy with T-DM1?

For premenopausal patients with early stage HR+ breast cancer for whom you are recommending tamoxifen, how do you select patients for extended endocrine therapy?

Are there clinical scenarios in which 5 years of tamoxifen alone remains sufficient?

Would a low or intermediate OncoType RS affect your choice of adjuvant endocrine therapy for a premenopausal woman with high clinical risk HR+ early stage disease?

Would you offer AI + OFS or tamoxifen to a woman with a grade 3 T2N0 tumor and OncoType of 15?

Would you offer additional therapy for a patient with HR+ breast cancer on AI+OS who is found to have a focus of ovarian metastasis at the time of elective BSO?

Additionally, would the finding of any mutations, such as ESR1, change your recommendation?

Would you consider adjuvant endocrine therapy for DCIS in a patient who received bilateral nipple-sparing mastectomies?

Endocrine therapy is usually not indicated for DCIS s/p bilateral mastectomy, but would the fact that residual tissue (nipple-sparing) alter your deci...

Does germline BRCA 1/2 mutation status impact your use of OncoType Dx for early stage ER positive breast cancers in post-menopausal women?

Would you offer adjuvant chemotherapy to a post-menopausal woman with a BRCA2 mutation and a T2N0 ER positive breast cancer with an oncotype of 12?

Would you offer adjuvant HER 2 directed therapy for ER+/PR+/HER2+ pT1-T2 N0 papillary carcinoma of the breast?

It is included in favorable histologies on NCCN, but no mention of how to treat based off HER2 status.

What is your preferred chemotherapy regimen for patients with peripheral neuropathy and high risk HR+/HER2- breast cancer?

What factors influence whether you order OncotypeDx in HR+ node negative ILC?

Does a complete pathologic response to neoadjuvant chemotherapy affect the duration of endocrine therapy/OFS that you recommend for a premenopausal patient with HR+/Her2+ breast cancer?

How do you decide which patients need extended adjuvant endocrine therapy?

How would you approach a patient with metastatic ER/PR+,HER2- breast cancer with linear leptomeningeal enhancement on MRI but negative CSF protein and cytology?

She had disease progression on palbociclib and letrozole. She also has a PIK3CA mutation however did not tolerate alpelisib due to Grade 3 hyperglycem...

How do you approach a post-menopausal female with early stage ER+,HER2+ breast cancer s/p lumpectomy with invasive ductal histology and lymph node involvement with invasive lobular histology?

Margins were negative and there was no evidence of LCIS or lobular component in the lumpectomy specimen. Role for possible mastectomy? ...

What adjuvant endocrine therapy would you recommend for patients who have undergone prior gastrectomy?

More generally, do absorption issues effect the efficacy of tamoxifen and/or aromatase inhibitors?

How would you approach a post-menopausal female with recurrent HR+, HER2- breast cancer with brain metastasis?

Prior localized HR+,HER2- breast cancer treated with adjuvant AC-T (5years ago) Recent ipsilateral axillary recurrence (HR-,HER2+) s/p neoadjuvant TC...

How would you approach a young patient with ER+/Her2- bilateral breast cancer with a solitary bone metastasis?

Would you consider an aggressive approach with RT and/or surgery to the bone lesion and treat the primary as locally advanced breast cancer?

How would you approach a patient with ER+,HER2- T4N0 breast cancer with chest wall involvement?

Role of neoadjuvant TC vs. anthracycline based regimen?

How would you manage a postmenopausal female with a history of early stage invasive ductal ER+/HER2- breast cancer s/p mastectomy who has a local recurrence of ER+/Her2 - lobular carcinoma while on letrozole?

How would you approach a post-menopausal women with recurrent ER/PR+, HER2- breast cancer only in the axillary lymph nodes?

< 4 lymph nodes involved, initial diagnosis was 11 years ago when she was treated with mastectomy and adjuvant tamoxifen for 5 years.

4 Answers available

What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?

Would you change treatment for denovo stage IV breast cancer Her 2 positive, ER positive in remission now with isolated brain metastasis?

The patient received THP and now is on maintenance HP when she developed CNS disease.

How would you treat a young patient with good performance status who has de novo metastatic HR+ Her2+ inflammatory breast cancer with asymptomatic leptomeningeal and CNS parenchymal disease?

Can you use Oncotype for determining adjuvant therapy in a young, premenopausal woman with multifocal HR+ breast cancer s/p mastectomy with 2 positive lymph nodes?

What is the role of neo-adjuvant chemotherapy in triple positive cT1c N0 breast cancer especially after recent data from KATHERINE trial?

Clinical T1c patients were included in the KATHERINE trial that often are treated with adjuvant paclitaxel and trastuzumab

Is a tumor ever too small to send off a genomic assay like Oncotype or Mammoprint in HR positive, HER2 negative stage 1 breast cancer?

There is a gray area in clinical decision making where the practice seems to be different for borderline size tumors such as a 7 mm lesion with no oth...