Her2+&nbsp;&nbsp;&nbsp;

How would you treat a patient with HER2 positive CNS only progression on fam-trastuzumab which had previously progressed on tucatinib/capecitabine/trastuzumab, and has failed both SRS and WBRT?

Would you give adjuvant TDM-1 to a patient with HER2-positive breast cancer s/p NAC with TCHP found to have no residual disease in the breast, but presence of ITCs ypN0(i+) in one axillary lymph node?

How would you approach a patient with DCIS (ER/PR/HER2 negative) with microinvasion in a SLN that is HER2 positive?

How would you manage new symptomatic brain metastases (10-15) in a young woman with HER2+ metastatic breast cancer?

Controlled extracranial disease on trastuzumab+pertuzumab for 2 years. Treatment options include switching systemic rx (T-Dxd, tucatinib) or WBRT. Not...

In a patient with stage IVB HER2 3+ high-grade serous endometrial cancer who had disease confined to a polyp and "microscopic" omental metastases, how long would you continue maintenance trastuzumab after chemotherapy?

What are your top takeaways in Medical Oncology from SABCS 2024?

13 Answers available

Would you use T-DXd or capecitabine/trastuzumab/tucatinib for HER2+ metastatic breast cancer with predominantly CNS progression after THP?

Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?

6 Answers available

What are your top takeaways in Breast Cancer from ESMO 2024?

Given the HELEN-006 trial results, under what circumstances, if any, would you consider de-escalated neoadjuvant therapy in HER2-positive breast cancer?

In this recently published phase 3 randomized controlled trial, neoadjuvant nab-paclitaxel/trastuzumab/pertuzumab x6 cycles appear to compare favorabl...

In which breast cancer presentation would you consider earlier treatment with T-DXd, given the similar absolute PFS benefits seen with T-DXd in the DESTINY-Breast06 trial and DESTINY-Breast04 trials?

How are you requesting testing for HER2-ultralow status, in light of DB-06 trial demonstrating benefit of T-DXd for these patients?

For a patient with well differentiated de novo triple positive metastatic breast cancer who did not respond to THP, do you sequence all available HER2 targeted options before endocrine therapy?

How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?

Would you offer adjuvant endocrine therapy for a postmenopausal female with stage III triple positive multicentric breast cancer (DCIS and invasive ductal carcinoma) s/p neoadjuvant TCHP followed by bilateral mastectomy with no residual disease?

What factors do you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2-low metastatic breast cancer?

Is there any data on the efficacy of T-Dxd after progression on sacituzumab govitecan? Does your approach differ by hormone receptor status now that ...

For patients with ER-negative HER2-ultralow breast cancer, how and when would you incorporate T-DXd?

Given that ER-negative patients were not enrolled to the DB06 trial, can results be extrapolated to this population?

For patients with metastatic HER2-null breast cancer, do you offer trastuzumab deruxtecan based on the DAISY trial results?

In patients with metastatic hormone receptor-positive, HER2-low breast cancer, how many and which lines of therapy would you recommend prior to using trastuzumab deruxtecan?

Are there any circumstances where use of T-DXd would supercede the use of CDK4/6 inhibitors or other non-chemotherapeutic options (PIK3CA etc?)

9 Answers available

What are your top takeaways in Breast Cancer from ASTRO 2024?

Do you offer hormonal therapy in combination with an anti-HER2 T-DM1 or T-DXd in metastatic ER+ HER2+ breast cancer?

Would you give chemotherapy and trastuzumab to a patient with multifocal high grade, microscopic (<5 mm) HR-, HER2+ IDC embedded in extensive DCIS, staged as pTis pT1a(m) N0?

Can trastuzumab deruxtecan be continued during radiation?

The patient has extensive disease, and requires palliative radiation to the scapular area (proximal to the brachial plexus) in a region overlapping wi...

What first line therapy would you give a premenopausal patient with HER-2 positive and ER positive metastatic breast cancer with visceral organ involvement?

Add OFS with endocrine therapy plus Taxane-HP combo? What taxane is preferred?

Are there strategies to mitigate the risk of developing ILD/pneumonitis while using trastuzumab deruxtecan?

Although grade 3 toxicity rates were low, ~10.5% experience some degree of ILD, are there strategies to reduce risk before treatment starts? Are ther...

When, if ever, will you utilize T-DM1 in metastatic HER2+ breast cancer given trastuzumab deruxtecan's significantly improved efficacy vs T-DM1?

Given the results of DESTINY-Breast03, and T-DXd's labeled indication in second-line, what is now the role of TDM1 in the treatment armamentarium of H...

7 Answers available

Would you still offer trastuzumab deruxtecan in a patient with progressive HR+/HER2+ breast cancer who has prior history of cell cycle inhibitor related pneumonitis?

What is the best second line treatment for a HER2+ metastatic breast cancer treated with frontline paclitaxel and anti-HER2 therapy?

Would you consider anthracycline based neoadjuvant therapy for ER negative, HER2 positive inflammatory breast cancer in a premenopausal female given the subset not adequately represented in non-anthracycline regimen trials?

How long would you continue trastuzumab for a patient with metastatic HER2+ esophageal adenocarcinoma whose tumor has achieved CR with FOLFOX + trastuzumab and has been disease-free for nearly 3 years?

What is your treatment approach in a patient with cT2 ER+HER2+ breast cancer who refuses neoadjuvant chemotherapy?

Would you consider using tucatinib in a patient with de-novo metastatic HER2+ HR(-) breast cancer patient with extensive intraparenchymal and leptomeningeal carcinomatosis?

Are there other systemic therapy considerations to help achieve sufficient CNS control?

Would you treat a patient with cT2 ER+/HER2+ breast cancer with neoadjuvant HER2 directed therapy if HER2 positivity is group 3?

Group 3 being ratio < 2, copy # >6, and IHC 2+

How do you decide whether to offer tamoxifen or OFS + AI in premenopausal patients with metastatic ER+ HER2+ breast cancer as your endocrine therapy?

What data may support the routine escalation of endocrine therapy? Should HER2 therapy be prioritized instead?

How long would you continue trastuzumab and pertuzumab in a patient with ER+ HER2+ breast cancer with initially osseous involvement treated with ACT-HP and is now in CR by PET for >2 years?

Do you feel comfortable using ribociclib in a patient with metastatic ER+/HER2+ breast cancer who has borderline systolic heart failure from previous HER2 based treatment?

Are you more worried about QT prolongation in this subset of patients?

What alternate neo-adjuvant backbone chemotherapy would you recommend in a patient with ER+ HER2+ clinical stage II breast CA with severe pan-colitis following a cycle of TCHP with docetaxel?

What is your preferred approach to third-line treatment of metastatic HER2 positive esophageal adenocarcinoma after progression on FOLFOX/CAPOX + trastuzumab, then T-DXd?

PD-L1 CPS of 1, no other actionable mutations except HER2.

How would you treat a patient with T1c HR-, HER2+ breast cancer, stage IV, with involvement of multiple bilateral axillary nodes and no evidence of distant metastasis?

Is there a role for further HER2 directed therapies after progression on fam-trastuzumab deruxtecan after a sustained initial response in patients with metastatic HER2+ colorectal cancer?

How would you treat a newly metastatic ER+ PR+ HER2+ triple positive breast cancer with diffuse symptomatic disease and severe neuropathy from prior adjuvant paclitaxel?

In a patient with ER+/HER2+ breast cancer with significant residual disease post neoadjuvant TCHP, is there a role of using CDK4/6i in the adjuvant setting with T-DM1?

Would a HER2 mutation on NGS of a biopsy of a breast cancer liver metastasis change your management if the met is HER2- by IHC with the initial localized disease being HER2+?

If NGS was positive would you treat with HER2 directed therapy? How, if at all, would you incorporate T-DXd into this treatment paradigm?

Would you give adjuvant endocrine therapy to a premenopausal woman with early stage node positive breast cancer that was ER negative, PR positive (60%) and HER2 positive?

She achieved PCR with NAC with TCHP and is now on adjuvant HP.

How do you approach adjuvant therapy to minimize cardiotoxicity in early stage node negative HER2+ HR+ breast cancer with history of chest wall radiation and previous cardiotoxic agents for Hodgkin Lymphoma?

How would you approach post-operative radiation in a patient with ER/PR negative Her2 positive, T1c N0 breast cancer originating in the ectopic mammary tissue close to the axilla, treated wide excision followed by APT regimen (weekly paclitaxel plus trastuzumab with trastuzumab for one year)?

What alternative regimens would you consider to neoadjuvant TCHP in setting of national carboplatin shortage for locally advanced HER2+ breast cancer?

Would you recommend olaparib for a patient with germline BRCA1 mutation and HER2+ metastatic breast cancer who has progressed through multiple lines of HER2-directed therapy including trastuzumab deruxtecan?

Does your approach differ across the HER2 IHC spectrum?

Would you include HER2 directed therapy in the treatment of HER2+ small bowel adenocarcinoma?

Do you test your esophageal and gastric specimens for HER2 using IHC, FISH, or both?

What other molecular tests do you routinely order on such tumors?

How would you continue management of a patient with clinical stage II cN+ HR+ HER2+IDC with grade 3 diarrhea after 1 cycle of neoadjuvant TCHP?

Would you consider use of T-DXd for metastatic gastric/GEJ cancers with "HER2 low" given emerging data in the breast cancer setting?

How do you consider first and subsequent lines of treatment sequencing in metastatic gastric/GEJ cancer that is both HER2+ and CPS>5?

How do you decide on 2nd line therapy in a patient with HER2+ metastatic esophageal/gastric cancer who progresses after initial response to trastuzumab-based chemotherapy?

Are there factors that would lead you to select either ramucirumab +/- paclitaxel vs T-Dxd vs chemo?

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

In what circumstances would you stop therapy for patients with metastatic HER2+ breast cancer with long-term complete response to HER2-directed therapy?

When do you consider HER2-targeting antibody drug conjugates in the first line setting for metastatic HER2 positive, ER negative breast cancer?

Given strong TDXd efficacy in these patients is there a role to use it earlier than 2nd line? How does prior Her2-directed and/or taxane therapy...

How would you approach a young patient with a prior ER+ HER2- breast CA now local recurrence that now has Her2 positive disease?

If a patient previously received taxane-based chemotherapy for the initial cancer, is additional chemotherapy recommended or can HER2-directed and hor...

How would you manage tucatinib-associated grade 2 indirect hyperbilirubinemia in a patient with metastatic HER2-positive breast cancer involving the CNS receiving trastuzumab + capecitabine + tucatinib?

Patient is young. Bilirubin normalizes when tucatinib is held, but again increases to grade 2 when it is restarted. Evaluation for hemolysis was negat...

What adjuvant therapy would you offer an elderly but healthy patient with T2N1 HR+ HER2+ breast cancer who is not willing to receive cytotoxic chemotherapy?

What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?

At initial diagnosis she had T1cN0 disease treated with lumpectomy and SLNB followed by 12 weeks of paclitaxel with 1 year of trastuzumab.

What neoadjuvant regimen would you give a patient with multicentric IDC consisting of TNBC and concurrent ER/PR- HER2+ breast cancer with ER/PR- HER2+ axillary LN mets?

How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?

Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2...

If a patient with HER2+ uterine serous carcinoma recurs while on maintenance trastuzumab, would you continue trastuzumab with second line chemotherapy?

Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.

What treatment would you provide for a patient with bilateral synchronous locally advanced cT4dN0 TNBC and cT1b ER+ HER2+ breast cancer?

Would you proceed with KEYNOTE 522 regimen and add anti-HER2 targeted therapy adjuvantly?

How would you adjust therapy for a HER2+ breast cancer patient found to have elevated LFTs while on TCHP?

What do you do if LFTs are elevated after one dose of neoadjuvant TCHP (highest ALT >13 times upper limit of normal, normal bilirubin) with prior n...

For a patient with metastatic gastric adenocarcinoma with CT showing NED after 4 months of FOLFOX + pembrolizumab + trastuzumab, would you consider resection of the primary and/or a chemo break?

Would your thinking change if the patient continues to be NED after an unplanned chemo break, e.g. for insurance issues?

How would you approach a patient who has developed neutropenia with the combination of trastuzumab/pertuzumab in the adjuvant setting?

Would you consider the discontinuation of either anti-HER2 agent or both?

How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...

Based on KEYNOTE-811, would you add pembrolizumab for HER2+ distal esophageal adenocarcinoma with new supraclavicular lymph nodes if treated previously with concurrent chemoradiation and PD-L1 CPS of 3?

What maintenance therapy, if any, do you offer patients with metastatic HER2+ esophageal or gastric cancer?

What combination of fluoropyrimidine, PD-1 inhibitor, or trastuzumab do you use?

0 Answers available

In a patient with metastatic HER2 positive breast cancer who has received prior TDM1 in the adjuvant setting for residual disease, would you consider reintroduction of TDM1?

The patient is intolerant to trastuzumab deruxtecan. In which clinical settings would you consider reintroduction of TDM1?

Would you offer immunotherapy in addition to chemotherapy and trastuzumab for patients with metastatic HER2 positive gastroesophageal cancer with low PDL1?

KEYNOTE 811 showed improved response rate with the addition of pembrolizumab, but very few patients in this study had low PDL1.

In which cases would you use adjuvant abemaciclib for a patient with extensive residual disease that is triple-positive (ER+PR+HER2+) following neoadjuvant TCHP?

Patient is ypT2N1

How would you approach systemic therapy for a pre-menopausal woman with ER+/PR+/HER2 positive breast cancer who had a local recurrence 6 months after completing adjuvant TCH and a year of trastuzumab + tamoxifen?

Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...

How do you interpret efficacy of trastuzumab deruxtecan based on HER2 mutation type and/or level of HER2 overexpression?

How and when do you plan to perform HER2 testing in patients with NSCLC?

Do you find data from phase 2 DESTINY-LUNG01 study sufficient to change practice in HER2 mutant NSCLC or is a phase 3 study still needed?

How does trastuzumab deruxtecan compare to other HER2 targeted strategies?

What is your approach to a patient with metastatic lung cancer with HER2 mutant NSCLC who is not a trial candidate?

How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use? Do you feel the dosing used in...

How would you manage adjuvant treatment of a premenopausal woman with HER2 positive, ER/PR negative multifocal micro-invasive node-negative breast cancer?

Largest invasive focus is 0.4mm

Is there a role for extended adjuvant neratinib with pCR after neoadjuvant chemotherapy in triple positive breast cancer?

With advancing and new therapies emerging for metastatic HER2+ breast cancer, how does one decide between options for third line therapy at time of progression?

How do you treat metastatic HER2 positive breast cancer in a patient with hepatic visceral crisis?

The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting.

What treatment options would you provide a HER2+/HR+ patient with significant residual disease s/p TCHP if they go on to develop severe neuropathy following adjuvant T-DM1 therapy?

Patient had an initial tumor response to TCHP, but still had significant residual disease present, including positive lymph nodes and residual breast ...

Would you consider adding HER2 targeted treatment to chemotherapy for a patient with locally advanced, HER2+ rectal cancer who is going to have total neoadjuvant treatment?

How would you manage adjuvant therapy for a premenopausal female with a T1cN1mi breast IDC that is HR+ HER2 positive on biopsy, but HR+ HER2 negative on lumpectomy surgical specimen?

<40y/o female w/ initial biopsy showing G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 copies/nucleus.)...

How would you treat HR positive, HER2 positive metastatic breast cancer in patients with a borderline or poor performance status?

How would you modify adjuvant therapy for a patient with ER+ HER2+ breast CA with no response to neoadjuvant TCHP and develops pneumonitis on adjuvant TDM-1?

Would you use trastuzumab/pertuzumab, trastuzumab followed by neratinib, or another strategy?

What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?

Would you choose to incorporate HER2-targeting agents, chemotherapy, endocrine therapy, or a mix of these?

How would you manage a patient with early stage ER+ HER2+ breast CA who cannot receive definitive local therapy due to severe cardiopulmonary co-morbidities?

How would your plan differ if the patient could eventually receive mastectomy once co-morbidities improve?

What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

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?

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-?

How does clinical intramammary lymph node involvement in HER2+ breast cancer affect your neoadjuvant chemotherapy choice?

Would you prefer TCHP over TCH? Would you consider adding an anthracycline?

How do you manage a HR-/HER2+ breast cancer patient with local progression during neoadjuvant TCHP?

How would you approach additional systemic therapy? Would the clinical stage of the cancer affect your management?

How do you approach a women with localized HER2+ breast cancer that was HER2+ by FISH but negative (0+) by IHC?

Would you modify your initial treatment for a patient with de novo metastatic HR- HER2+ breast CA who has cardiomyopathy at baseline (EF < 35)?

Is there any safety data to proceed with TKIs/TDM-1 or to proceed as standard with THP?

How long would you keep a patient on endocrine/dual anti HER-2 therapy after resection of a late (>5 years) oligometastatic recurrence of ER+ HER2+ breast CA?

For patients who remain NED for years, when would you feel it's appropriate to hold therapy?

What systemic therapy would you choose for elderly patients with HER2+ breast CA who have early metastatic relapse (within months) of completing adjuvant trastuzumab/paclitaxel?

What would you offer if the patient is not a candidate for cytotoxic therapy?

Do you routinely add endocrine therapy to anti-HER2 maintenance therapy after 6 cycles of THP for metastatic ER+ HER2+ breast CA?

In what situations would you offer systemic therapy for HER2+ microinvasive invasive ductal carcinoma?

Do you give adjuvant chemotherapy/trastuzumab to a premenopausal woman with a pT1aN0 HR+, Her2+ breast cancer?

Would you give a HER2 targeted agent to a patient whose initial cancer was ER/PR positive, HER2 negative but now with metastatic disease that is ER positive, PR negative, HER2 2+, FISH equivocal?

Patient has progressed through prior lines of endocrine therapy.

How would you manage adjuvant treatment of a patient with ER+/PR+/HER2+ breast cancer and a small amount of residual disease (e.g. T1mi) following neoadjuvant TCHP?

Patient had a clinical T2N0 cancer at diagnosis, completed 6 cycles TCHP, and had 0.2mm residual disease with 80% cellularity, negative sentinel node.

What non-taxane chemotherapy, if any, would you give with trastuzumab in adjuvant setting of a pT1cN0 HER2+ breast CA in patients with hyperbilirubinemia >3 due to cirrhosis?

Is there any role for alpelisib in a patient who has triple positive breast cancer and an activating PIK3CA mutation?

Would you treat an ER/PR+ inflammatory breast cancer that is HER2 2+ by IHC but 5% positive by FISH as HER2 positive?

2 populations of cells with 95% negative by FISH (ratio 1.07) and 5% positive by FISH (ratio 10)

Would you offer adjuvant TDM-1 to a patient with residual disease after neoadjuvant treatment for biopsy proven HER2 positive breast cancer, although residual tumor biopsy shows discordance with HER2 negative status?

How do you manage ovarian suppression for premenopausal patients with HR+/HER2 positive breast cancer?

Does lymph node positivity change your management?

Is it acceptable to use TCHP instead of AC-T + trastuzumab as neoadjuvant chemotherapy for HER2+ inflammatory breast cancer?

Patient case is triple positive inflammatory breast cancer

Are docetaxel and paclitaxel interchangeable for stage II-III HER2+ breast cancer patients receiving neoadjuvant chemotherapy with AC-THP?

Are there any studies that compare them?

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?

For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?

Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.

Is there a role for endocrine therapy alone in patients with metastatic HR+, HER2+ breast cancer after all HER2 directed therapies have been used?

How do you approach the re-challenge with trastuzumab in metastatic HER2+ patients who develop cardiomyopathy on trastuzumab/pertuzumab with subsequent improvement with discontinuation?

Do you repeat the loading dose of trastuzumab?

What second line treatment would you choose for a post menopausal woman with HR+ HER2+ metastatic breast cancer with low burden disease treated with first line aromatase inhibitor and trastuzumab?

What adjuvant treatment would you recommend for a Stage I HER2 positive breast cancer with grade 3 neuropathy from previous taxane treatment?

What systemic therapy would you consider, if any, for an isolated but multifocal CNS recurrence of HER2+ HR negative breast cancer treated with local therapy (>4 lesions treated with resection and SRS)?

Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.

What systemic treatment would you offer for metastatic HER2+ breast cancer that has progressed through THP and TDM-1 with predominant CNS progression and without localized treatment options?

Given the changing landscape of treatment, some patients may have already received capecitabine previously. Would this impact your treatment rec...

How would you approach adjuvant treatment of an early stage HR+ HER2+ cancer if the patient had already been taking an aromatase inhibitor for a contra-lateral HR+ early stage breast cancer?

Interest in approach for elderly population especially

How would you change the regimen for a patient receiving neoadjuvant TCHP or node positive HR+/HER2+ breast cancer who develops a severe allergic reaction to docetaxel?

Would you consider an anthracycline based substitution vs changing to nab-paclitaxel or a combination with platinum agent?

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?

How do you approach HER2 directed therapy with discrepant results between FISH and Oncotype?

Especially if HER2 negative on pathological specimen

Would you hold pertuzumab around the time of surgery?

How would you approach systemic therapy for a postmenopausal female with metastatic ER+/HER2+ breast cancer (liver/bone) who achieved a CR for 5 years on trastuzumab/pertuzumab and exemestane, with continued asymptomatic brain progression?

Asymptomatic brain progression despite CNS surgery and SRS x2 over the past 2 years.

What is your approach to oligometastatic HER2 positive breast cancer, particularly after excellent clinical response in all sites of disease to trastuzumab, pertuzumab, and a taxane?

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?

Would you consider adjuvant TDM-1 for a patient with HR+,HER2+ breast cancer with pCR in the breast but N1mic disease post neoaduvant chemotherapy?

Do you ever stop pertuzumab for stable disease in a patient with metastatic, HER2 positive breast with stable disease?

In cases where patient received 6 cycles of THP and 1 year of HP

Would you use tucatinib in a patient with recurrent HER2+ breast cancer with isolated brain metastasis with leptomeningeal disease?

Patient received adjuvant chemotherapy and anti-Her2 therapy 3 years ago.

Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive, ER negative breast cancer?

If yes, would you offer tamoxifen or ovarian suppression plus AI?

How would you approach a postmenopausal patient with HR-,HER2+ breast cancer who has oligometastatic disease, and is s/p complete resection of brain met with no other evidence of systemic disease?

Received adjuvant HER2 directed therapy 3 years ago.

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...

Do you recommend routine surveillance MRI brain for asymptomatic patients with metastatic HER2+ breast cancer?

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...

For a HER2 positive patient who has undergone neoadjuvant HER2-directed therapy, do you offer adjuvant trastuzumab if the surgical specimen is HER2 negative?

What adjuvant therapy would you recommend to elderly patients with pT2N0 ER-/PR-/HER2+ breast cancer?

The APT trial reported excellent DFS, OS and RFI for tumors <=3cm but few were smaller T2s (2-3 cm) and few were >70 years old.

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

Stage T1bN1mic

Would you offer neoadjuvant chemotherapy to premenopausal women with cT1cN0 HER2+ breast cancer?

For a post-menopausal woman with a pT1c node negative HER2 positive breast cancer, does ER status influence your choice of adjuvant paclitaxel/trastuzumab versus docetaxel/carboplatin/trastuzumab?

This is a patient with a 1.8cm node negative HER2 positive tumor that is grade 3, high Ki67, and ER positive.

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?

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.

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 would you approach a patient with a HER2+ locoregional recurrence who did not receive prior systemic therapy?

Patient only had upfront surgery.

Do you give bisphosphonates after completing adjuvant anti-HER2 therapy and chemotherapy for HER2+ breast cancer to reduce the risk of recurrence?

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?

How would you approach a post-menopausal female with both a previously HR+ HER2- breast cancer and HR- HER2+ breast cancer with new brain metastasis?

How would you figure out how to treat someone with a prior localized HR+,HER2- breast cancer treated with adjuvant AC-T (5years ago) and a recent ipsi...

Do you use trastuzumab for patients with localized HER2+ esophageal cancer after definitive chemoRT who are not surgical candidates?

Do you utilize it immediately following chemoRT or wait until disease progression?

How would you approach a patient with metastatic ER+/Her2+ who has progressed on trastuzumab/pertuzumab + tamoxifen after being in remission for 4yrs?

Should neoadjuvant chemotherapy be recommended for HER2+, clinically LN- breast cancer measuring 2-3cm?

If yes, would you still recommend dual HER2 directed therapy? After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has beco...

Do you offer neoadjuvant therapy to a postmenopausal cT1cN0 , HER2+, ER/PR+ breast IDC or recommend surgery first?

For patients with HER2+ breast cancer with a resectable HER2+ local relapse within 12 months of completion of standard adjuvant therapy including 1 year of trastuzumab, what adjuvant therapy would you recommend?

Does hormone receptor status impact your decision?

How do you use neratinib in HR+ HER2+ patients in the adjuvant setting if patients got adjuvant T-DM1 for residual disease after neoadjuvant therapy?

Neratinib was studied following adjuvant trastuzumab. Do you extrapolate that data to give neratinib to patients who have received adjuvant T-DM1 inst...

For triple positive metastatic breast cancer, is there a role for aromatase inhibitor + CDK 4/6 inhibitor with Her2 directed therapy in a patient that refuses chemotherapy?

Patient defers chemotherapy. She is currently on anastrozole/Herceptin and perjeta with a response but it is suboptimal. I would like to add a CDK 4/6...

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?

In patients with stage II-III HER2+ breast cancer who were not treated with neoadjuvant therapy, without having knowledge of response to neoadjuvant therapy (i.e. pCR or not) after chemotherapy, what is your preferred adjuvant HER2 directed therapy?

Which patients should receive TDM-1, Trastuzumab+Pertuzumab or Trastuzumab alone?

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

Would you offer a mid-treatment transition from transtuzumab to TDM-1 for a patient already on 1 year of adjuvant trastuzumab who met criteria for adjuvant TDM-1 based on the KATHERINE trial?

Any factors that would impact this decision (how far along adjuvant trastuzumab, disease characteristics, etc)?

Would you switch to TDM-1 in the adjuvant setting in HER-2 positive breast cancer patients with residual disease after neoadjuvant chemotherapy if neoadjuvant chemotherapy did not include anthracyclines?

Only a small subset (22-24%) of patients in Katherine trial received a non-anthracycline containing regimen.

How do you utilize CDK 4/6 inhibitors in metastatic ER+ HER2+ breast cancer?

One such patient progressed through trastuzumab/pertuzumab/letrozole and TDM1 alone. How would you combine ER+ approaches (eg CDK 4/6 inhibitor ...

How do you manage elderly women with high-risk HER2 positive disease with baseline low ejection fraction?

For example, in a patient > 70 years old?

Will you offer adjuvant T-DM1 for patients with HER2+ breast cancer who have residual invasive disease following neoadjuvant therapy?

Will you incorporate the results from KATHERINE into clinical practice now?

Would you consider adjuvant capecitabine as well as trastuzumab in a patient with ER/PR negative, HER2 positive breast cancer treated with neoadjuvant chemotherapy /trastuzumab/pertuzumab who has residual disease on path?

The CREATE-X trial did not include HER-2 positive patients but the ER-negative population benefited from capecitabine. Would you consider capecitabine...

Do you consider multifocal disease an indication for chemotherapy with trastuzumab in patients with microinvasive Her2+/HR- breast cancer?

Is there data supporting the omission of carboplatin from neoadjuvant TCHP therapy for HER2-positive breast cancer to reduce toxicity, particularly in light of findings from the KATHERINE study?

Would you use paclitaxel and trastuzumab in ER negative, HER2+ breast cancer with micrometastases in a single node?

The NEJM 2015 paper by Tolaney et al only included 1.5% of patients with micrometastases.

Would you use 6 months (instead of 12 months) of trastuzumab for locally advanced Her-2 positive breast cancer patients?

Would you do this for ER+ patients? According to the PERSEPHONE trial presented on ASCO 2018, in HER2+, non-metastatic breast cancer, 6 months Hercep...

What neoadjuvant chemotherapy regimen would you choose for a young patient with HER2 positive breast cancer with reduced ejection fraction?

Is there any evidence to use trastuzumab and pertuzumab without doxorubicin?

Do you routinely check echocardiograms for patients getting HER2 directed therapy for metastatic breast cancer?

If so, how frequently?

How do you assess the risk of cardiotoxicity from HER2+ agents?

What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?

How does it vary for patients with a history of hypertension, diabetes, CHF, and coronary artery disease?

Would you consider stopping chemotherapy and continuing trastuzumab alone in a patient with metastatic HER2 positive GEJ cancer who had a complete response to chemotherapy and trastuzumab?

How do you minimize the risk of cardiotoxicity in metastatic Her2 + breast cancer patients who are receiving trastuzumab and have a history of pre-existing cardiac disease?

What is your preferred regimen for triple positive breast cancer with visceral metastasis while on adjuvant AI?

Would you consider using CKD inhibitors upfront in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Hercepti...

What is your preferred regimen for triple positive breast cancer with bone only recurrence?

Would you consider using ckd inhibitors in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Herceptin? NCCN ...

In which Her2+ breast cancer patients would you recommend extended adjuvant therapy with neratinib?

The FDA recently approved neratinib based on data from the ExteNET trial; however, benefit appears modest and the risk of toxicity is not low.

Would you use lapatinib to prevent recurrence of brain mets in a patient with recurrent brain-only mets from HER2+ breast cancer now rendered NED after radiation?

Will you continue anti-estrogen therapy in the setting of initiation of TDM-1 for patients with metastatic ER+/HER2+ breast cancer?

For women with metastatic HER2 + breast cancer who achieve a complete response, how long do you continue on HER2-directed therapies?

Do you ever consider de-escalating or stopping therapy in this situation? What is your approach to this conversation?

Is there a role for any of the CDK4/6 inhibitors in ER+/HER2+ or ER-/HER2+ metastatic breast cancer?