Breast Cancer, Metastatic

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

3 Answers available

In which clinical settings do you use the Cerianna (fluoroestradiol F18) PET scan for breast cancer?

2 Answers available

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

13 Answers available

In patients with advanced HR+, HER2- breast cancer who have progressed on first-line CDK 4/6i and ET and found to have ESR1 mutation, are you offering combination of abemaciclib and elacestrant in the 2nd line or SERD monotherapy?

1 Answer available

Is there any benefit of anastrozole in addition to fulvestrant and palbociclib in a patient with HR+ metastatic breast cancer?

1 Answer 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 is your recommended treatment sequencing strategy in patients with HER2+ breast cancer and leptomeningeal carcinomatosis?

Considering DB-12 study's exclusion of patients with leptomeningeal metastases, can T-DXd still be integrated into treatment plans for these patients?...

3 Answers available

How do you treat leptomeningeal disease in metastatic HR+ HER2- breast cancer?

The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases).

1 Answer available

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

4 Answers available

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?

3 Answers available

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

3 Answers available

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?

5 Answers available

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

3 Answers available

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 ...

4 Answers available

In what situations would you consider doublet chemotherapy in treatment of a premenopausal de novo metastatic TNBC?

2 Answers available

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?

2 Answers available

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

4 Answers available

What are your top takeaways from ESMO 2023?

10 Answers available

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

Do you use elacestrant for all patients with metastatic ER+, HER2-, ESR1 mutated breast cancer regardless of duration of response to prior ET+CDK4/6i?

2 Answers available

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

4 Answers available

How do you sequence everolimus/endocrine therapy versus fam-trastuzumab deruxtecan after progression on CDK4/6i in metastatic ER+ HER2 low breast cancer?

1 Answer available

In what circumstance, if any, would you consider fulvestrant + capivasertib over CDK4/6 inhibitors in a patient who has HR+, PIK3CA mutant metastatic breast cancer?

3 Answers available

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

2 Answers available

Is there a correlation with severity of rash as an adverse event and response rate with capivasertib?

1 Answer available

Are there scenarios where you would consider use of capivasertib for non-AKT pathway altered patients given the efficacy seen in the overall treatment population of the CAPItello-291 trial?

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

3 Answers available

In which scenarios do you stage breast cancer using CT and nuclear bone scans versus PET-CT?

3 Answers available

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...

1 Answer available

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?

1 Answer available

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...

3 Answers available

Are you comfortable combining palliative radiotherapy with capivasertib/fulvestrant?

Any pitfalls to be aware of?

1 Answer available

Do you use breast MRI or ultrasound to assess tumor size prior to neoadjuvant chemotherapy in breast cancer?

1 Answer available

Do you start systemic therapy for patients with previously localized HR+ breast cancer developing solitary bone metastasis which is now triple negative if there are no other sites of disease after metastasis-directed radiation?

8 Answers available

Would you offer local therapy with either SBRT or Y-90 in a patient with metastatic ER+ HER2 low breast cancer with two oligometastatic liver lesions currently on AI + CDK4/6 inhibitor?

1 Answer available

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

In patients with HER-2 positive breast cancer on pertuzumab/trastuzumab with newly developed asymptomatic brain metastases only, do you wait 3 weeks after administration of the targeted therapy to deliver SRS?

3 Answers available

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

11 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?

2 Answers available

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

2 Answers available

How do you treat metastatic breast cancer which is HR positive, Her2 negative with PIK3CA+ and high tumor mutational burden (>10) who progressed after prior ET+CDK 4/6 and PIK3CA inhibitor therapy?

1 Answer available

What is the current paradigm for breast cancer diagnosed with isolated metastases prior to initial treatment?

Is there a role for loco-regional treatment in this scenario? If a young patient with ER/PR positive cT2N2M1 IDC presents with a single bone metastasi...

1 Answer available

How do you treat metastatic adenoid cystic carcinoma of breast primary, ER 3%, PR, HER 2 negative with liver only metastasis?

1 Answer available

Would you use elacestrant in a patient with an ESR1-AKAP12 fusion?

1 Answer available

Would you offer capivasertib+fulvestrant in a patient with metastatic HR+ HER2 negative breast cancer with PTEN mutation who has progressed on fulvestrant plus ribociclib?

3 Answers available

How do you define PIK3CA/AKT/PTEN alteration for capivasertib use?

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...

2 Answers available

What disease characteristics will guide your choice of alpelisib plus fulvestrant (per SOLAR-1) versus capivasertib plus fulvestrant (per CAPItello-291) in PIK3CA mutated advanced ER+/HER2- breast cancer after progression on 1L ET regimen, given both are now approved in this population?

3 Answers available

Would you use sequential CDK 4/6 inhibitors in HR-positive metastatic breast CA in successive lines of therapy?

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...

5 Answers available

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?

1 Answer available

When should paclitaxel (or other chemo) be discontinued in de novo metastatic triple negative breast cancer with high PDL1 in favor of continuing pembrolizumab alone with good treatment response?

1 Answer available

Do you routinely check echocardiograms on all patients who are starting TDM1?

1 Answer available

How should we think about endocrine resistance in patients with inherited germline mutations such as BRCA, CHEK2, etc.?

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...

1 Answer available

How would you treat a patient with symptomatic and rapidly progressing metastatic HR+, HER2 low breast cancer with PIK3CA WT, ESR1 mutated, TMB high after progression on CDK 4/6 inhibitor, a taxane, and T-DXd?

1 Answer available

Do you recommend the use of elacestrant after prior fulvestrant in metastatic hormone positive breast cancer?

1 Answer available

For a patient with metastatic HR positive breast cancer presenting with spinal cord compression but no visceral metastases, what is your recommended first line systemic therapy?

Would you start with endocrine therapy + CDK 4/6 inhibitor or a chemotherapy based regimen?

2 Answers available

What is your preferred first line therapy for metastatic HR+ inflammatory breast cancer?

1 Answer available

In light of RIGHT Choice trial data, when will you opt for a CDK 4/6 inhibitor plus AI instead of chemotherapy in patients with metastatic HR-positive HER2-negative breast cancer with visceral crisis?

RIGHT Choice trial presented at SABCS 2022

3 Answers available

What is your preferred chemotherapy when dealing with hepatic visceral crisis in metastatic breast cancer?

How does this change for patients with elevated bilirubin?

4 Answers available

Are there any scenarios you would use CDK 4/6i to treat HR-positive HER2-positive breast cancer in combination with anti-HER2 agents?

1 Answer available

Is there any role for elacestrant in patient who have received prior fulvestrant if they have ESR1 mutation?

3 Answers available

How do you approach treatment of patients with metastatic HR+ breast cancer with detection of ESR1 mutation after initiation of an AI and CDK4/6 Inhibitor?

How does data from PADA-1 and EMERALD trials impact your decision-making?

3 Answers available

Would you start fulvestrant plus CDK4/6 inhibitors in a patient with ESR1 mutation with metastatic breast cancer on liquid biopsy in a first-line setting?

3 Answers available

If a patient is unable to tolerate one CDK 4/6 inhibitor, do you switch to a different one?

For example, a patient has had multiple dose reductions for neutropenia and required an admission for infection while on palbociclib. Would you switch...

3 Answers available

What are your top takeaways from SABCS 2023?

4 Answers available

Is there a role for Elacestrant in ER+ metastatic breast cancer with ESR1-YAP1 fusion on NGS?

1 Answer available

What is the preferred sequence of systemic therapy in a patient with endocrine resistant HR+ metastatic breast cancer?

The patient previously received endocrine therapy alone and in combination with CDK 4/6 inhibitor. She does not have any targetable mutations on NGS. ...

3 Answers available

Does the degree of ER/PR positivity influence your treatment option in the patient with newly diagnosed metastatic breast cancer?

Would you treat with 1st line ET + CDK4/6 inhibitor if the patient is only low or moderately ER positive?

3 Answers available

Would you consider reserving CDK4/6 Inhibitors as second line treatment in patients with advanced HR+ HER2 negative breast cancer given SONIA and PALMIRA trial results?

2 Answers available

Would you consider AI alone over CDK4/6 inhibitor combinations in older patients with breast cancer considering the subgroup analyses from MONALEESA-2 suggest less benefit in patients over 65?

4 Answers available

What is your approach to treatment in hormone receptor positive, HER2 negative (0 IHC) metastatic breast cancer with ERBB2 gene amplification after progression on AI and fulvestrant CDK4/6i with visceral crisis?

1 Answer available

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?

1 Answer available

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?

1 Answer available

Do you give systemic therapy for triple negative breast cancer with brain metastasis and no other sites of disease?

Following SRS to the brain lesions, is it safe to closely follow the patient for recurrence?

4 Answers available

Do you switch therapy to sacituzumab in a patient with metastatic HR+ HER2- breast cancer who has stable systemic disease but new <1cm brain metastasis?

1 Answer available

How would you treat a patient with bilateral synchronous breast cancers and evidence of metastatic disease on imaging when one breast has a triple negative cancer and the other breast has a ER/PR negative HER2+ cancer?

Would you biopsy a metastatic site?

1 Answer available

How would you treat newly diagnosed metastatic HER2 positive breast cancer with liquid NGS revealed ERBB2 L755S mutation (a marker for resistance against trastuzumab)?

1 Answer available

Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?

2 Answers available

What is your approach in treatment of oligometastatic triple negative inflammatory breast cancer?

1 Answer available

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?

1 Answer available

What would be your approach to first line therapy for patient with metastatic HER2 positive breast cancer with CHF (LVEF <50%)?

Is there absolute LVEF threshold you would not use HER2 targeted therapies?

1 Answer available

Is there a role for systemic therapy in recurrent oligometastatic triple negative breast cancer with brain only disease?

1 Answer available

Since the publication of DESTINY-Breast-04 have you implemented new institutional practices for characterization of HER2-low disease given known limitations in pathologist IHC evaluation?

3 Answers available

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?

5 Answers available

What are your top takeaways in Breast Cancer from ASCO 2023?

4 Answers available

In metastatic TNBC with germline or somatic BRCA mutation, when is the preferred time to introduce a PARP inhibitor?

In which scenarios would you consider a parp inhibitor as the first line treatment of choice?

6 Answers available

Do you prefer CDK 4/6 inhibitor or PARP inhibitor as first line treatment in a patient with HR+/HER2 neg relapsed/metastatic BRCA positive breast cancer who had previous adjuvant chemotherapy and developed metastatic recurrence while on AI?

6 Answers available

What is your systemic therapy of choice for patients with metastatic small cell carcinoma of breast origin?

1 Answer available

Would you consider a PARPi for a patient with PALB2 mutated metastatic triple negative breast cancer?

If yes, where in sequence would you use it?

3 Answers available

How do you decide between 1st line PARPi or immunotherapy in a patient with metastatic gBRCA mutated TNBC?

Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...

4 Answers available

How do you decide between a PARP inhibitor or alpelisib for patients with metastatic ER+, gBRCA+, PI3K mutated breast CA with progression on CDK 4/6 inhibitor/fulvestrant?

4 Answers available

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?

4 Answers available

What is your treatment approach in metastatic breast cancer with osseous metastases resulting in significant cytopenias?

1 Answer available

Would you consider chemoimmunotherapy in a patient with hormone positive breast cancer treated with chemotherapy who has progressed to triple negative breast cancer?

1 Answer available

How do you select systemic therapy for recurrent HR+ HER2 negative breast cancer in the bones in a premenopausal woman within a year of starting adjuvant AI with OFS plus abemaciclib and zoledronic acid?

She had been initially treated with neoadjuvant AC-T followed by BCS and RT with high burden residual disease in the breast and lymph nodes.

1 Answer available

How do you approach systemic treatment for intracranial only brain metastases for ER positive, PR negative, HER2 negative breast cancer after stereotactic radiosurgery for brain metastases with negative PET imaging?

1 Answer available

Would you offer curative intent therapy to a patient with a new diagnosis of breast cancer with multiple small lung nodules (<1cm not amenable to biopsy) as the only possible site of metastatic disease?

2 Answers available

How would you treat bilateral synchronous breast cancer with single bony metastatic disease on imaging when one is ER+ HER2 neg and other is TNBC?

1 Answer available

How do you approach continuation versus cessation of systemic therapy for patients with stage IV triple negative breast cancer with a prolonged complete response to therapy and who are tolerating therapy well?

1 Answer available

How do you decide among approved CDK4/6 inhibitors for first line treatment of patients with metastatic HR+ breast cancer now that OS analyses are available in MONALEESA-2, MONARCH-3 and PALOMA-2?

How do you compare their efficacy overall?

5 Answers available

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?&...

5 Answers available

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...

5 Answers available

How does your treatment approach vary in patients with HR+/HER2- breast cancer presenting with CNS metastases?

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...

2 Answers available

How would you manage subsequent treatment for a patient with metastatic ER+HER2- breast cancer that develops pneumonitis on a CDK4/6 inhibitor but had an excellent response to therapy?

Would you change to a different CDK4/6 inhibitor or avoid the entire class of drugs?

2 Answers available

How do you select your first-line endocrine therapy to accompany CDK4/6 inhibitor in metastatic HR+ breast cancer?

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

1 Answer available

Do you think about CDK4/6 inhibitor selection differently in a patient with de novo rather than recurrent metastatic disease?

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...

2 Answers available

Would you drop the duration of palbociclib from 1-21 days to 1-14 days if still neutropenic with 75 mg dose in metastatic breast cancer?

1 Answer available

What are your top takeaways from SABCS 2022?

5 Answers available

How do you incorporate ctDNA in the management of metastatic breast cancer?

1 Answer available

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...

2 Answers available

What criteria would you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2 low metastatic TNBC given T-DXd approval in HER2 low breast cancer?

2 Answers available

If there is HER2-low discordance between primary and subsequent breast cancer biopsies, in which scenarios would you choose to use trastuzumab deruxtecan?

For example, if the primary breast tumor was HER2 IHC 1+, but a metastatic site was HER2 IHC 0, would you still recommend using T-DXd? Will you chang...

4 Answers available

What are your treatment options for HER2 over-expressing metastatic breast cancer in a patient whose LVEF decreased to <50% from normal baseline on HER2-directed therapy and EF fails to improve after holding therapy for 2 months?

1 Answer available

Do you ever offer scalp cooling therapy to metastatic breast cancer patients wishing to avoid alopecia?

1 Answer available

What is trastuzumab deruxtecan's activity for patients with CNS+ disease?

Is there evidence that T-DXd crosses the blood-brain barrier?

3 Answers available

When defining HER2-low status in breast cancer, are there certain IHC assays/techniques that are preferred?

Prior studies have shown that there can be significant variation between grading pathologists as to which samples are defined as HER2 IHC +1 versus HE...

4 Answers available

How will you approach treatment sequencing and use of trastuzumab deruxtecan in hormone receptor-negative, HER2-low breast cancer?

Specifically, how do you consider T-DXd use in setting of other antibody-drug conjugates (e.g. sacituzumab vedotin)? Are there any special considerati...

4 Answers available

Would you give palliative breast RT to a patient receiving weekly paclitaxel for rapidly progressing metastatic disease?

If a patient has a painful breast lesion in the setting of rapidly progressing systemic disease treated with weekly taxol (60 mg/m2), would you feel c...

3 Answers available

In patients with breast cancer and concern for bone-only metastases on imaging but with non-diagnostic IR biopsies, do you pursue surgical bone resection for diagnosis or treat empirically for metastatic disease based on pathology from breast lesion?

1 Answer available

Are there differences in T-DXd efficacy along the spectrum of HER2 IHC expression to impact treatment decisions or sequencing?

For example, are you more likely to incorporate T-DXd earlier in sequence for 2+ vs 1+? Is there any justification to change our approach in HER2-zer...

3 Answers available

Do you continue endocrine therapy for women with HER2+/HR+ metastatic breast cancer when starting a HER2-directed antibody-drug-conjugate?

1 Answer available

Do you recommend maintenance immunotherapy after CR on chemotherapy for patients with metastatic TNBC?

In patients with prior perioperative immunotherapy with early relapse, would re-introduction of immunotherapy be reasonable with high TMB?

2 Answers available

What are your top takeaways in Breast Cancer from ASCO 2022?

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice? ...

12 Answers available

How would you approach a young patient with oligometastatic inflammatory triple negative breast cancer with bone only metastases?

Would you consider definitive local therapy (surgery, radiation?) if she achieved a good response to initial systemic therapy?

3 Answers available

What is optimal endocrine therapy in a young, premenopausal women with ER/PR positive oligometastic breast cancer successfully treated with curative intent neoadjuvant chemo followed by surgery+RT to skeletal oligomet?

Would you include a CDK4/6 inhibitor knowing the patient doesn't meet criteria of monarchE trial but still is Stage IV?

1 Answer 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?

1 Answer available

Is there a clinically significant increased risk of venous thromboembolism with the use of fulvestrant for metastatic HR+ breast cancer?

In a patient with a history of VTE (now off anticoagulants), is it safe to administer fulvestrant?

1 Answer available

How do you address and mitigate neutropenia in patients with TNBC receiving sacituzumab govitecan in 3rd line or beyond?

Many of the patients on ASCENT trial were heavily pre-treated and require growth factors. With the day 1,8 treatment cycle, is there a way to minimize...

4 Answers available

In which scenarios would you utilize sacituzumab govitecan earlier than third line in the treatment of metastatic TNBC?

Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? ...

4 Answers available

How has the ASCENT trial impacted your management of previously treated metastatic TNBC?

Are there specific patient cohorts in whom you will more preferentially use sacituzumab govitecan? Can data from ASCENT be applied to patients with C...

3 Answers available

Are there known biomarkers predictive of response or resistance to sacituzumab govitecan which should be incorporated into treatment decisions for metastatic TNBC?

Are there differences in outcome among the BRCA mutated subgroup, or others?

2 Answers available

How do you counsel patients with metastatic TNBC on their various treatment options after progression on first line regimens?

To what degree do you factor in patient preference when choosing among available treatments? Are there features of each regimen that you emphasize in ...

3 Answers available

For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?

CNS recurrence occurred within two years of prior neoadjuvant therapy

1 Answer available

Would you consider a CDK 4/6 inhibitor in combination with endocrine therapy for a patient with ER low (1-9%) metastatic breast cancer?

In which situations would you consider this a reasonable treatment option?

1 Answer available

Would you consider use of PARP inhibitors in patients with metastatic breast cancer with moderate penetrance germline mutations such as CHEK2, ATM, RAD51?

What about a higher penetrance PV such as PALB2? See JCO OGR 8/2021 by @Mark E. Robson discussing management of non-BRCA pathogenic va...

3 Answers available

What is the optimal sequence of systemic therapy for a patient with HR+, gBRCA mutated metastatic breast cancer?

1 Answer available

Would you consider a treatment holiday in a patient with HR+ oligometastatic breast cancer who is in a prolonged remission?

The patient initially received definitive therapy with AC-T and RT to the breast as well as RT to a solitary bone lesion. She has been on AI for the l...

3 Answers available

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?

2 Answers available

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.

2 Answers available

For patients with metastatic triple negative breast cancer on nab-paclitaxel + atezolizumab who have an ongoing response, are you continuing immunotherapy after the FDA withdrawal of atezolizumab?

1 Answer available

How do you manage HR+HER2 negative ILC metastatic recurrence in a post-menopausal woman with extensive GI involvement complicated by a small bowel obstruction?

Patient was on tamoxifen when progression occurred; unable to tolerate adjuvant AI.

1 Answer available

In a patient with metastatic TNBC on chemoimmunotherapy for several years and a near complete response, would you consider an immunotherapy holiday?

The patient was started on chemoimmunotherapy 3 years ago. Recent scans show small treated brain metastases (s/p RT several years ago) and no disease ...

2 Answers available

Would you consider surgical management of a TNBC primary after a patient has had radiographic resolution of oligometastatic disease?

Patient with T2N1 disease and isolated liver metastases. Axilla and liver completely responded to chemo + IO, but limited residual breast enhancement ...

2 Answers available

Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?

Do any studies support this rationale? Does the presence of a somatic vs germline BRCA mutation impact your decision?

1 Answer available

Would you consider de-escalating treatment to endocrine therapy alone in a patient with prolonged NED on CDK 4/6 inhibitor + endocrine therapy?

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?

1 Answer available

What is your preferred bone modifying agent and frequency of dosing in patients with breast cancer and bony metastases?

Do you discuss patient visits and associated costs when making this decision?

1 Answer available

How do you treat leptomeningeal carcinomatosis in metastatic breast cancer?

Do you consider placing an Ommaya for IT chemo with methotrexate or cytarabine? Knowing that leptomeningeal carcinomatosis carries such...

1 Answer available

Do you recommend switching from chemotherapy to AI+CDK4/6 inhibitor after resolution of visceral crisis in a patient with HR+, HER2- metastatic breast cancer?

If so, after how many cycles of chemotherapy would you switch?

5 Answers available

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...

2 Answers available

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 ...

1 Answer available

Do you hold palbociclib (or another CDK4/6 inhibitor) in a patient with metastatic HR+ breast cancer while receiving palliative radiation?

4 Answers available

Papers discussed in this category

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

Pertuzumab plus trastuzumab plus docetaxel for metastatic breast cancer.

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

Trastuzumab emtansine for HER2-positive advanced breast cancer.

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

T-DM1 Activity in Metastatic Human Epidermal Growth Factor Receptor 2-Positive Breast Cancers That Received Prior Therapy With Trastuzumab and Pertuzumab.

N Engl J Med,

Trastuzumab Deruxtecan versus Trastuzumab Emtansine for Breast Cancer.

N Engl J Med, 2019 Dec 11

Trastuzumab Deruxtecan in Previously Treated HER2-Positive Breast Cancer.

N Engl J Med,

Overall Survival with Ribociclib plus Letrozole in Advanced Breast Cancer.

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

MONARCH 2: Abemaciclib in Combination With Fulvestrant in Women With HR+/HER2- Advanced Breast Cancer Who Had Progressed While Receiving Endocrine Therapy.

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

MONARCH 1, A Phase II Study of Abemaciclib, a CDK4 and CDK6 Inhibitor, as a Single Agent, in Patients with Refractory HR/HER2 Metastatic Breast Cancer.

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

Randomized Phase II Trial of Endocrine Therapy With or Without Ribociclib After Progression on Cyclin-Dependent Kinase 4/6 Inhibition in Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: MAINTAIN Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-07-10

Prognostic Impact of 21-Gene Recurrence Score in Patients With Stage IV Breast Cancer: TBCRC 013.

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

Combination anastrozole and fulvestrant in metastatic breast cancer.

J. Clin. Oncol., 2015 Feb 17

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Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2023 Jul 10

Safety profile of trastuzumab-emtansine (T-DM1) with concurrent radiation therapy: A systematic review and meta-analysis.

Cancers, 2022 Jan 08

Stereotactic Radiation and Dual Human Epidermal Growth Factor Receptor 2 Blockade with Trastuzumab and Pertuzumab in the Treatment of Breast Cancer Brain Metastases: A Single Institution Series.

Cancers, 2023 Apr 13

Interaction between Radiation Therapy and Targeted Therapies in HER2-Positive Breast Cancer: Literature Review, Levels of Evidence for Safety and Recommendations for Optimal Treatment Sequence.

Nature reviews. Clinical oncology, 2021 Feb 08

Unlocking the potential of antibody-drug conjugates for cancer therapy.

JAMA oncology, 2023 Dec 01

Symptomatic Necrosis With Antibody-Drug Conjugates and Concurrent Stereotactic Radiotherapy for Brain Metastases.

Breast cancer research and treatment, 2018-06

Targeting the PI3K/AKT/mTOR pathway in triple-negative breast cancer: a review.

Breast cancer research : BCR, 2020 Nov 02

Phase 2 study of buparlisib (BKM120), a pan-class I PI3K inhibitor, in patients with metastatic triple-negative breast cancer.

The New England journal of medicine, 2024 Oct 31

Inavolisib-Based Therapy in PIK3CA-Mutated Advanced Breast Cancer.

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

Targeting the PI3-kinase pathway in triple-negative breast cancer.

Cancer letters, 2022 Jun 03

Kinase inhibitors for precision therapy of triple-negative breast cancer: Progress, challenges, and new perspectives on targeting this heterogeneous disease.

Cancers, 2023 Feb 23

Phosphoinositide 3-Kinase (PI3K) Inhibitors and Breast Cancer: An Overview of Current Achievements.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-01

TBCRC 022: A Phase II Trial of Neratinib and Capecitabine for Patients With Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases.

Breast cancer research : BCR, 2020 Nov 30

Phase II trial of carboplatin and bevacizumab in patients with breast cancer brain metastases.

Cureus, 2017 Dec 25

Fractionated Radiosurgery Alone for Thirty-seven Brain Metastases: Not Everything that can be Counted Counts.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-11-20

Lapatinib combined with letrozole versus letrozole and placebo as first-line therapy for postmenopausal hormone receptor-positive metastatic breast cancer.

Proceedings of the National Academy of Sciences of the United States of America, 2006-05-16

A model of acquired autoresistance to a potent ErbB2 tyrosine kinase inhibitor and a therapeutic strategy to prevent its onset in breast cancer.

Cell,

Combination Cancer Therapy Can Confer Benefit via Patient-to-Patient Variability without Drug Additivity or Synergy.

Endocrinology, 2003 Mar

Elevated levels of epidermal growth factor receptor/c-erbB2 heterodimers mediate an autocrine growth regulatory pathway in tamoxifen-resistant MCF-7 cells.

Therapeutic advances in medical oncology, 2023 Aug 11

Evolving perspectives on the treatment of HR+/HER2+ metastatic breast cancer.

Annals of oncology : official journal of the European Society for Medical Oncology, 2024 Oct 21

A phase III trial of adjuvant ribociclib plus endocrine therapy vs endocrine therapy alone in patients with HR+/HER2- early breast cancer: final invasive disease-free survival results from the NATALEE trial.

The New England journal of medicine, 2024 Sep 15

Overall Survival with Pembrolizumab in Early-Stage Triple-Negative Breast Cancer.

BMJ Open, 2019 Oct 15

Pragmatic randomised clinical trial of proton versus photon therapy for patients with non-metastatic breast cancer: the Radiotherapy Comparative Effectiveness (RadComp) Consortium trial protocol.

J Clin Oncol, 2020 Jul 30

Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial.

JAMA oncology, 2024 Oct 01

Hypofractionated vs Conventionally Fractionated Postmastectomy Radiation After Implant-Based Reconstruction: A Randomized Clinical Trial.

Lancet Oncol., 2019 Jan 30

Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial.

Clin Cancer Res, 2024 Oct 1

Elacestrant in ER+, HER2- Metastatic Breast Cancer with ESR1-Mutated Tumors: Subgroup Analyses from the Phase III EMERALD Trial by Prior Duration of Endocrine Therapy plus CDK4/6 Inhibitor and in Clinical Subgroups.

Med (New York, N.Y.), 2024 Sep 11

The DEBBRAH trial: Trastuzumab deruxtecan in HER2-positive and HER2-low breast cancer patients with leptomeningeal carcinomatosis.

NPJ breast cancer, 2023 Oct 11

Treatment with trastuzumab deruxtecan in patients with HER2-positive breast cancer and brain metastases and/or leptomeningeal disease (ROSET-BM).

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-10-15

Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less.

Eur. J. Cancer, 2010-01-01

Radiation therapy and tamoxifen after breast-conserving surgery: updated results of a 2 x 2 randomised clinical trial in patients with low risk of recurrence.

J. Clin. Oncol., 2016-12-20

Postmastectomy Radiotherapy: An American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Focused Guideline Update.

Journal of the National Cancer Institute, 2017-01

21-Gene Recurrence Score and Locoregional Recurrence in Node-Positive/ER-Positive Breast Cancer Treated With Chemo-Endocrine Therapy.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2001-03-01

Postmastectomy radiotherapy: clinical practice guidelines of the American Society of Clinical Oncology.

JAMA oncology, 2023 Sep 21

Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial.

The Lancet. Oncology, 2024 Dec 11

Single-modality endocrine therapy versus radiotherapy after breast-conserving surgery in women aged 70 years and older with luminal A-like early breast cancer (EUROPA): a preplanned interim analysis of a phase 3, non-inferiority, randomised trial.

The New England journal of medicine, 2024 Dec 12

Axillary Surgery in Breast Cancer - Primary Results of the INSEMA Trial.

Annals of surgery, 2011 Aug

Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Sep 06

Imlunestrant, an Oral Selective Estrogen Receptor Degrader, as Monotherapy and in Combination With Targeted Therapy in Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Advanced Breast Cancer: Phase Ia/Ib EMBER Study.

The New England journal of medicine, 2024 Dec 11

Imlunestrant with or without Abemaciclib in Advanced Breast Cancer.

Clinical breast cancer, 2019 Nov 14

T-DM1 Efficacy in Patients With HER2-positive Metastatic Breast Cancer Progressing After a Taxane Plus Pertuzumab and Trastuzumab: An Italian Multicenter Observational Study.

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

Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial.

N Engl J Med,

Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer.

JAMA Oncol, 2021 Dec 1

Fulvestrant-Palbociclib vs Letrozole-Palbociclib as Initial Therapy for Endocrine-Sensitive, Hormone Receptor-Positive, ERBB2-Negative Advanced Breast Cancer: A Randomized Clinical Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2024 Sep 12

Datopotamab Deruxtecan Versus Chemotherapy in Previously Treated Inoperable/Metastatic Hormone Receptor-Positive Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer: Primary Results From TROPION-Breast01.

Breast Cancer, Metastatic

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