NCI-CCC Breast Tumor Board Question   

Questions discussed in this category



38 y/o female had a biopsy of a palpable mass that showed G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 c...

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?

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

Is adjuvant radiation and/or adjuvant chemotherapy indicated? 

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 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...

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

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...

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


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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

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The breast journal, 2017-11

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JAMA,

Cancer Prev Res (Phila), 2019 Aug 16

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J Clin Oncol, 2019 Sep 18

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

N Engl J Med, 2015 Jan 8

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J Clin Oncol, 2021 Feb 04