Breast Cancer, Metastatic   

Questions discussed in this category

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

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...

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...

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

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...

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

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...

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

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

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...

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...

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

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

The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TD...

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

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

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...

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

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...

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

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

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

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

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...

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

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...

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

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 ...

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

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? 

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

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...

Papers discussed in this category

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N Engl J Med, 2019 Dec 11

N Engl J Med,

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

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

Semin Cell Dev Biol, 2011 Jul 28

Nat Med, 2019 Sep 30

J Clin Oncol, 2020 Oct 29

Radiother Oncol, 2017 Sep 27

Cancer Treat Rev, 2022 Mar 12

J Clin Oncol, 2020 May 29

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

Cancer Manag Res, 2012 Jun 13

Ann Oncol, 2007 Feb 13

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-12-10

Lancet Oncol, 2020 Aug 27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-09-20

N Engl J Med, 2021 Apr 22

N Engl J Med,

Cancer Discov, 2021 Aug 17

Ann Oncol, 2021 Mar 16

Annals of oncology : official journal of the European Society for Medical Oncology, 2001-09

Cochrane Database Syst Rev, 2021 May 26

J. Clin. Oncol., 2020 Sep 20

Clin Cancer Res, 2020 Jan 1

JAMA Oncol, 2019 Sep 29

J Clin Oncol, 2021 Mar 26

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-10-10

JAMA Oncol,

The Lancet. Oncology, 2017-06

Breast Cancer Res Treat, 2018 Jul 04

Eur J Haematol, 2021 Feb 18

Clin Cancer Res, 2022 Jan 19

JCO Precis Oncol, 2019 Nov 15

Br J Cancer, 2021 Jan 21

The Lancet. Oncology, 2019-06

J Clin Oncol, 2020 Feb 14

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

The New England journal of medicine, 2018-08-23

Breast Cancer Res Treat, 2016 Feb 18

Mol Cancer Ther, 2018 Mar 28

Eur J Cancer, 2014 Aug 12


J Clin Oncol, 2022 Jan 07

N Engl J Med, 2022 Jun 05

N. Engl. J. Med.,

N Engl J Med,

J Natl Compr Canc Netw, 2021 Mar 24

N Engl J Med, 2018 Oct 20

Cancer Discov, 2020 Nov 02

J Clin Oncol, 2019 Nov 04

Ann Oncol, 2021 Jul 01

N Engl J Med,


J. Clin. Oncol., 2018 May 30

Virchows Arch, 2022 Aug 16

Int J Mol Sci, 2020 Sep 03

The New England journal of medicine, 1987-12-10

Korean J Intern Med, 2020 Feb 28

International journal of radiation oncology, biology, physics, 2012-04-01

Breast cancer research and treatment, 2019-06

Nat Med, 2022 Aug 08

Lancet Oncol., 2020 Mar 12

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

Clin Cancer Res, 2022 Mar 01

Breast cancer research : BCR, 2018-10-19

Curr Probl Cancer, 2016 Mar - Aug

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

Breast Care (Basel), 2019 Nov 26

Cancer Chemother Pharmacol, 2019 May 11

Clin Cancer Res, 2020 Jul 21

NPJ Breast Cancer, 2022 Mar 21

J Clin Oncol, 2022 May 18

Lancet, 2022 Dec 06

, 2022 Dec

N Engl J Med, 2021 Dec 01

Clin Cancer Res, 2022 Feb 15