HR+   

Questions discussed in this category



Patient with stage IV ER+PR+Her2- breast cancer progressed after CDK4/6 inhibitor+AI and then on Elacestrant. Guardant 360 showed ESR1 mutation and PI...

PFS curves appear similar between the AKT-altered vs overall study population in the trial publication. Is there any additional information available ...

In MONALEESA-2, it appears ~22% of those in the ribcociclib group received a subsequent CDK4/6 inhibitor. What was the rationale and could this have i...

Do you give first-line CDK 4/6 inhibitors with Tamoxifen or Aromatase Inhibitor (+/- GnRH analog)?

Should these patients have a different threshold for utilizing a CDK4/6 inhibitor in the front line metastatic or as part of adjuvant therapy, or SERD...

Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...

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

How do you reconcile the apparent benefit in all patients in this group as opposed to the differential effects in premenopausal HR+ node-negative pati...

What type of adjuvant chemotherapy would you offer? Would clinically positive lymph nodes or residual disease at the time of surgery change your decis...

MONARCHE added an amendment to their protocol to exclude inflammatory breast cancer so they technically would not qualify for the trial though it's ha...

Patient is pre-menopausal and has cT3cN1, grade 2, ER positive, Her 2 negative IDC. Metastatic disease to axillary LNs was biopsy-proven. Patient was ...

Is deferring chemotherapy based on low oncotype acceptable in setting of recurrence?    Would you recommend using a different AI, Tam...

Would you recommend using chemotherapy based on RxPonder regardless of Oncotype score in a premenopausal patient? Or would you hold chemotherapy since...

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

(Assuming they meet MonarchE criteria) For example, if the patient is in year 2, 3, 4, or 5 of adjuvant endocrine therapy versus 9 months out, would ...

Is there a role for KEYNOTE-522 since ER + metaplastic breast cancer have similar behavior to triple negative metaplastic breast cancer? 

Do you use a q4 week or q12 week formulation? If you use both in your practice, what factors into your decision making for either one?

While rare, these patients were excluded from all frontline CDK4/6 inhibitor trials. Is there any data on the efficacy of ribociclib in the CNS or abi...

Results with fulvestrant and letrozole backbone in MONALEESA and MONARCH trials seem comparable, but PALOMA data is somewhat mixed. How do these trial...

Subgroup analyses in MONALEESA-2 suggest more benefit in de novo treatment naive patients, which is in contrast to MONARCH-3 data presented at ESMO 20...

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

Is the marginal advantage of AC/T in 1-3 node positive outweighed by toxicity such as risk of cardiotoxicity and leukemia, regardless of RS?

Can you use 50 mg BID if intolerant to 150 mg and 100 mg dosing? Any tips for side effect management to help patients stay on full duration?

MonarchE shows statistically significant improvement in IDFS and DRFS, but the magnitude of absolute benefit is modest (3-year IDFS and DRFS rates = 5...

Majority of patients on MonarchE received neoadjuvant/adjuvant chemo.  Does the availability of abemaciclib impact your decision to offer chemo ...

Do you look into their stage/risk to decide? Since patients can experience bone loss after stopping denosumab, how do you plan to discontinue?

What steps should be taken when switching premenopausal women from tamoxifen to AI? In this case, the change is due to newly discovered endometrial th...

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

Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?

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

Patient is young and reoccurrence is one year after initial diagnosis of T1cN0 ER/PR positive, HER2-negative breast cancer treated with mastectomy, bu...

In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...

Patient underwent mastectomy for DCIS in the setting of previous lumpectomy and adjuvant radiation for the invasive breast cancer. 

Should this be sent on initial biopsy or on surgical pathology? What if an initially high risk patient has good risk findings post-operatively?What ha...

How would you manage endocrine therapy 7 years after the original ER+/PR+/HER2- IDC, while on adjuvant tamoxifen/OFS develops a contralateral ER+/PR+/...

For example, does a higher recurrence score influence your choice of TC versus AC-T?  Or your choice to add ovarian suppression to a premenopausa...

Patient is on fulvestrant+CDK 4/6 inhibitor and with NED for 5 years. In which cases would you consider stopping CDK 4/6 inhibitor? 

<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.)...

Is there an age cutoff below which you would offer adjuvant chemotherapy regardless of Oncotype results? (Example: A 35 y/o woman with T2N0, ER+, sen...

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

Are there particular patient characteristics (e.g. age, ER%, Ki67, grade) that make you more likely to choose neoadjuvant endocrine therapy?

Do features such as nodal involvement, Ki-67, degree of ER positivity, etc. change your management? Would you use any gene expression assays to help y...

Would you consider an Oncotype or Mammaprint? Would your management change if the patient had 1-3 positive LNs on SLNBx (as opposed to ALND)?

The woman was on on a GnRH agonist + AI due to her premenopausal status at diagnosis and now wants to know if she continues to need the GnRH agonist.&...

Knowing the differential effect seen with menopausal status in RxPONDER, would you avoid chemotherapy or still offer chemotherapy, given that only 15....

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

Referring to a high risk patient with cT3N1 disease and ypT2N0 disease following neoadjuvant chemotherapy.

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

Based on MINDACT update from 2020, a 5% difference in DMFS for patients 50 years or younger was noted, favoring treatment with chemotherapy (93.6%; 95...

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

Pre-menopausal women make progesterone and their menses are typically lighter on tamoxifen because it's a mild endometrial ER stimulant blocking their...

How has your practice been impacted by the ECOG 2108 (Khan et al. ASCO 2020 Abst LBA2)? Are there sites or distribution of disease that prompt you to ...

She had had 4 prior biopsies. Would the fact that she received 2 months of neoadjuvant tamoxifen due to COVID change your approach?

While the KATHERINE trial for HER2+ used path staging, CREATE-X for TNBC with capecitabine used the Japanese Breast Cancer Society response criteria. ...

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

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

Data from the SOFT/TEXT trials showed clinical benefit in ovarian suppression + aromatase inhibition for high risk, premenopausal ...

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

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

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)...

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...

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...

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?

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

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

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

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...

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

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

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...

The use of neoadjuvant CDK 4/6 inhibitors is not standard of care, but there are clinical trials looking at this question and patients who are chemoth...

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

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

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 T1b lesion with no...

Do you have a cutoff in terms of tumor size, number of LN, Oncotype score, etc that makes you choose lower vs higher intensity chemo?

Assume good compliance with oral therapy, equivalent access to either agent, no contraindictions to either therapy, and absence of any visceral crisis...


Papers discussed in this category


The New England journal of medicine, 2018-07-12

Clinical breast cancer, 2010-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-10

Lancet (London, England), 2014-03-22

The New England journal of medicine, 2011-06-23

Journal of the National Cancer Institute, 2005-09-07

The New England journal of medicine, 2016-07-21

European radiology, 2022 May 07

The Cochrane database of systematic reviews, 2020 Dec 21

N Engl J Med,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-09-01

Clinical cancer research : an official journal of the American Association for Cancer Research, 2017 May 22

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 May 19

Lancet (London, England), 2016-12-17

Breast cancer research and treatment, 2014-01

Lancet (London, England), 2013-03-09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-04-20

Journal of the National Cancer Institute, 2013-07-17

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-09-01

The Lancet. Oncology, 2019-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10

J. Clin. Oncol., 2019 Oct 16

Cancer, 2010-11-15

The breast journal, 2017-11

The Lancet. Oncology, 2017-12

N. Engl. J. Med., 2017-07-13

Lancet Oncol., 2016-06-01

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-09

JAMA Oncol,

NPJ Breast Cancer, 2021 Nov 11

J Clin Oncol, 2020 Feb 25

Mol Oncol,

JAMA,

N Engl J Med, 2015 Jan 8

Lancet Oncol., 2017 Feb 24

Eur. J. Cancer, 2017 May 03

The New England journal of medicine, 2012-01-12

J. Clin. Oncol., 2018 Dec 06

The New England journal of medicine, 2016-08-25

Journal of the National Comprehensive Cancer Network : JNCCN, 2017-04

Journal of neurosurgery, 2019-02-08

Breast cancer research and treatment, 2018-06

Trials, 2013 Aug 19

Ann. Oncol., 2012 Jun 06

Cancer,

Annals of surgical oncology, 2014-10

N. Engl. J. Med.,

Ann Surg Oncol, 2022 Apr 04

The New England journal of medicine, 2019-02-14

Oncotarget,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-04-10

The New England journal of medicine, 2012-08-02

The Lancet. Oncology, 2014-02

Annals of surgical oncology, 2018-10

Annals of surgery, 2019-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-08-01

N Engl J Med, 2011 Oct 6

Lancet (London, England), 2012-02-04

Breast cancer research and treatment, 2008-01

Cancer, 1998-02-15

Cancer, 2010-04-15

N. Engl. J. Med.,

Breast cancer research and treatment, 2011-07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-05-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005-06-01

N Engl J Med, 2005 Jun 2

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-10-10

N Engl J Med,

Cancer, 2016-04-15

The New England journal of medicine, 2019-06-20

Ann. Oncol.,

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2017-09

Springerplus, 2016 May 10

JAMA dermatology, 2018-06-01

The New England journal of medicine, 2014-07-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10

The American journal of surgical pathology, 2017-11

N. Engl. J. Med.,

Oncologist, 2020 Jul 03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-11-15

N. Engl. J. Med., 2017 Jun 04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-08-10

JAMA Oncol, 2019 Sep 30

JAMA,

N Engl J Med, 2020 Mar 27

J. Clin. Oncol., 2019 Jul 24

Anticancer Res.,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-07-01

The New England journal of medicine, 2018-07-12

Lancet Oncol., 2018 Nov 06

J. Clin. Oncol., 2019 Oct 16

Breast Cancer Res. Treat., 2006 May 11

Lancet Oncol., 2009 Nov 10

J Clin Oncol, 2020 Apr 10

Breast cancer research and treatment, 2014-11

The Lancet. Oncology, 2016-03

Mol Clin Oncol, 2019 Nov 29

Clin. Cancer Res., 2019 Oct 24

The American journal of surgical pathology, 2006-06

J Clin Oncol, 2019 Apr 11

Cancer Treat. Rev., 2012 Nov 28

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

Cancer, 2016-12-01

N. Engl. J. Med.,

The Lancet. Oncology, 2014-06

The New England journal of medicine, 2012-11-08

N. Engl. J. Med., 2019 Dec 11

Lancet Oncol., 2020 Mar 12

J. Clin. Oncol., 2009 Sep 28

Lancet Oncol, 2020 Apr 27

Journal of the National Cancer Institute, 2005-11-16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Cancer, 2020 Jun 10

Journal of the National Cancer Institute, 1997-11-19

Journal of surgical oncology, 2017-06

Breast cancer research and treatment, 2015-11

Breast Cancer Res Treat, 2020 May 20

Lancet Oncol., 2014-06-01

The Lancet. Oncology, 2018-04

Pathol Oncol Res, 2017 Sep 11

J Clin Oncol, 2020 Jan 13

NPJ Breast Cancer,

Breast cancer research : BCR, 2004

Lancet Oncol., 2014-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-08-01

Breast cancer research and treatment, 2018-09

J. Clin. Oncol., 2020 Sep 20

Breast J, 2019 Jul 04

J Clin Oncol, 2020 Oct 29

Breast cancer research and treatment, 2011-10

J. Clin. Oncol., 2018 May 30

Cancer Treat Rev, 2013 Jun 10

Clin Cancer Res, 2019 Sep 12

Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-12-01

Cancer, 2010-05-15

Circulation, 2020 Feb 17

J Clin Oncol, 2018 Aug 14

J Clin Oncol, 2020 Sep 16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-07-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-07-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-09-10

Breast, 2011 Sep 08

Sci Rep, 2019 Dec 02

Annals of oncology : official journal of the European Society for Medical Oncology, 2005-08

J Clin Oncol, 2020 Oct 27

Annals of Oncology, 2021 Sep 29

Cancer Manag Res, 2012 Jun 13

Ann Oncol, 2007 Feb 13

J Clin Oncol, 2021 Feb 04

Clin Cancer Res, 2020 Jul 21

NPJ breast cancer, 2023 Oct 23

Neuro-oncology, 2023 Jan 05

JAMA, 2011-02-09

JAMA oncology, 2017-11-01

J Natl Cancer Inst, 2011 Jul 09

Br J Clin Pharmacol, 2020 Jun 02

Clin Breast Cancer, 2020 Oct 06

Clin Cancer Res, 2017 Mar 07

Lancet Oncol, 2019 Dec 11

Ann Oncol,

Ann Oncol, 2022 Mar 23

Journal of the National Cancer Institute, 2011-11-16

Archives of pathology & laboratory medicine, 2016-01

Lancet Oncol,

J Clin Oncol, 2009 Apr 20

Clin Cancer Res,

N Engl J Med, 2021 Jun 03

J Natl Compr Canc Netw, 2021 Mar 24

J Clin Oncol, 2022 May 18

Annals of oncology : official journal of the European Society for Medical Oncology, 2020 Nov 25

The New England journal of medicine, 2023 Jun 01

The Lancet. Oncology, 2022 Sep 29

Breast Cancer Res Treat, 2018 Jul 04

Eur J Haematol, 2021 Feb 18

Cancer Sci,

Oncotarget, 2017 May 10

Breast Cancer Res Treat, 2020 Sep 10

Lancet Oncol, 2022 Dec 06

J Clin Oncol, 2011 Oct 31

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-05-10

Lancet, 2019 Dec 12

Lancet (London, England), 2016-02-27

N Engl J Med, 2021 Dec 01

N Engl J Med,

N Engl J Med, 2022 Jun 05

Int J Mol Sci, 2020 Sep 03

J Clin Oncol, 2022 Jan 07

Ann Surg,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-04-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-12-10

Breast Cancer Res, 2021 Aug 23

The New England journal of medicine, 2016-11-17

Clin Cancer Res, 2022 Mar 01

Annals of oncology : official journal of the European Society for Medical Oncology, 2022 Oct 10

Curr Probl Cancer, 2016 Mar - Aug

Journal of the National Cancer Institute, 2000-04-05

Breast cancer research : BCR, 2018-10-19

Breast Care (Basel), 2019 Nov 26

Cancer Chemother Pharmacol, 2019 May 11

Front Oncol, 2020 May 29

Cancer Cell Int, 2021 May 17

Ann Gastroenterol, 2020 Jan-Feb

BMC Cancer, 2019 Oct 21

JAMA Oncol, 2021 Sep 01

Clin Cancer Res, 2021 Feb 19

Clin Cancer Res, 2022 Feb 15

Clin Cancer Res, 2020 Nov 18

Lancet, 2023 Apr 15

J Natl Cancer Inst, 2007 Dec 25

Br J Cancer, 2022 Feb 22

JAMA Oncol, 2020 Aug 13

Annals of oncology : official journal of the European Society for Medical Oncology, 2014-05

J Clin Pathol, 2016 Sep 09

Breast Cancer, 2018 Jul 31

Annals of oncology : official journal of the European Society for Medical Oncology, 2003 Aug

Helvetica chirurgica acta, 1989 Apr

Annals of surgical oncology, 2012 May 23

JAMA, 2021 Apr 06

Breast cancer research and treatment, 2023 Jun 15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2021 Jan 29

Ther Adv Med Oncol, 2022

Annals of oncology : official journal of the European Society for Medical Oncology, 2019 Dec 01

Breast cancer research and treatment, 2020 Aug 10

JCO precision oncology, 2022 Mar

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-09-10

The oncologist, 2022 Mar 28

The Journal of clinical investigation, 2010-07

Science translational medicine, 2015-04-15

Cancer discovery, 2020 May 13

Clinical cancer research : an official journal of the American Association for Cancer Research, 2022 Mar 01

Molecular cancer therapeutics, 2012 Jan 31

Signal transduction and targeted therapy, 2021 Dec 16

International journal of molecular sciences, 2021 Dec 16