NCI-CCC Breast Tumor Board Question   

Questions discussed in this category


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

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

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

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

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

(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 ...

Patient has already received neo/adjuvant treatment with AC, paclitaxel, capecitabine, docetaxel, and carboplatin.

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

Patient previously received neoadjuvant ddAC-T with residual disease at surgery, followed by adjuvant capecitabine which was completed 2 months prior ...

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 ...

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

<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.)...

Would you offer this patient chemotherapy? What are your thoughts about OFS plus AI and avoiding chemotherapy?

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...

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

Is adjuvant radiation and/or adjuvant chemotherapy indicated? 

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)?

For patients with low risk, early stage, hormone receptor positive, HER2 negative breast cancer who initiated endocrine therapy in order to delay thei...

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

For example, will you recommend a certain vaccination timing in relationship to their treatment? Any concerns for reduced immune response or risks of ...

Does tumor size impact your recommendation? High grade? Young patient age?

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

For a patient with high risk disease and a severe enough reaction that additional taxane-based therapy is contraindicated, do you consider alternate c...

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

Is there any evidence for sacituzumab govitecan (IMMU-132) in this situation with progressive systemic disease after prior anthracycline and taxane?

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

Would you consider genomic assays before neoadjuvant chemotherapy? How would you modify your treatment given the COVID-19 pandemic?

Following the dosage guidelines based on absolute neutrophil count may cause the patient to end up receiving lower doses.

(For instance, TCX4 instead of AC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemotherap...


Papers discussed in this category


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-03-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-03-10

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

Cancer, 2010-11-15

The breast journal, 2017-11

Clinical cancer research : an official journal of the American Association for Cancer Research, 2012-12-15

JAMA oncology, 2017-07-01

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

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

PLoS ONE, 2018 May 16

The Lancet. Oncology, 2017-12

N. Engl. J. Med.,

Breast, 2013 Dec 22

Breast, 2015 Oct 09

Lancet Oncol., 2020 Feb 14

The Lancet. Oncology, 2010-10

Breast Cancer Res. Treat.,

International journal of radiation oncology, biology, physics, 2005-07-15

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

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, 2010-04-20

J. Clin. Oncol., 2019 Oct 16

Breast cancer research and treatment, 2014-11

The Lancet. Oncology, 2016-03

N Engl J Med, 2018 Oct 20

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

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

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-07-20

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

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

JAMA Oncol, 2020 Aug 13

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

N Engl J Med,

Cancer, 2020 Jun 10

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

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

Journal of surgical oncology, 2017-06

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

Annals of oncology : official journal of the European Society for Medical Oncology, 2000-08

N Engl J Med, 2011 Oct 6

Lancet Oncol., 2012-01-01

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

Lancet Oncol., 2018 Nov 06

Obstet Gynecol,

JAMA,

Cancer Prev Res (Phila), 2019 Aug 16

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

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

N. Engl. J. Med., 2015-01-29

J Clin Oncol, 2019 Sep 18

Cancer, 2000-03-15

Front Oncol, 2020 Dec 03

Annals of surgical oncology, 2018-07

Clin Imaging, 2021 Feb 10

Clinical breast cancer, 2008-06

Clinical cancer research : an official journal of the American Association for Cancer Research, 2017-02-01

Breast Cancer Res, 2020 Nov 04

Breast Cancer Res Treat, 2011 Jul 27

Clin Breast Cancer, 2019 May 24

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

N Engl J Med, 2015 Jan 8

Cancer Manag Res, 2012 Jun 13

Ann Oncol, 2007 Feb 13

J Clin Oncol, 2021 Feb 04

JAMA, 2011-02-09

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

Clin Cancer Res,

Mol Cell Endocrinol, 2021 Jan 26

J. Clin. Oncol., 2020 Sep 20

Annals of Oncology, 2021 Sep 29

Cancer, 2019 Jul 18

J Clin Oncol, 2021 Dec 10

The Lancet. Oncology, 2014-02

Front Oncol, 2018 Apr 17

N. Engl. J. Med.,

Cancer Sci,

Oncotarget, 2017 May 10

Breast Cancer Res Treat, 2020 Sep 10

Lancet,

J Clin Oncol, 2022 Jan 18

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

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., 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

N Engl J Med, 2021 Jun 03