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Would you consider adjuvant endocrine therapy for DCIS in a patient who received bilateral nipple-sparing mastectomies?

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

For premenopausal patients with ER/PR+ Her2 negative breast cancer and lymph node micrometastases, would recurrence score be most appropriately interpreted based on TAILORx data, given such patients were excluded from RxPONDER?

In patients who have received neoadjuvant endocrine therapy for localized ER/PR+, HER2 negative breast cancer, how do you decide which patients to offer adjuvant chemotherapy to?

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

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?

If you have a high risk HR+, BRCA+ breast cancer patient who qualifies for adjuvant olaparib and abemaciclib, which one would you give and why?

Would you ever consider using these in sequence?

What is your approach to adjuvant hormone therapy for HR+ breast cancer in post-menopausal women with pre-existing osteoporosis?

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

How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?

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

Would you be comfortable starting tamoxifen for a HR+ breast cancer patient with a history of early stage endometrial cancer treated via hysterectomy?

Would you offer adjuvant chemotherapy to a post menopausal woman with T1-T3 primary tumor with 4 positive axillary LNs and OncotypeDX score less than 15?

How would you approach adjuvant therapy for a premenopausal female with HR+, HER2+ breast cancer with N1mic disease?

Stage T1bN1mic

In which situations do you offer neoadjuvant chemotherapy for a nodal recurrence alone of ER/PR positive, HER2 negative breast cancer?

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

Do you plan to offer adjuvant olaparib to all gBRCA+ breast cancer whether TNBC or HR+?

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

How would you treat a post-menopausal woman found to have a node-negative ipsilateral HR+ breast cancer recurrence with pectoral muscle invasion following a prior mastectomy, radiation, and AI therapy completed > 5 years ago?

What is your approach to chemoprevention for HR+ DCIS in the ipsilateral breast in a patient who already completed 7 years of an AI for a prior HR+ invasive breast cancer?

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

For patients with prior HR+HER2- localized breast cancer currently receiving adjuvant endocrine therapy, is there a time period in which you would no longer recommend adding adjuvant abemaciclib?

(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 ...

How and on which specimens will you perform Ki-67 testing in newly diagnosed 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...

What adjuvant therapy would you offer an elderly but healthy patient with T2N1 HR+ HER2+ breast cancer who is not willing to receive cytotoxic chemotherapy?

How do you incorporate oncotype Dx recurrence score when planning adjuvant CDK 4/6 inhibitor for high risk early stage HR+ breast cancer?

Would you offer adjuvant abemaciclib to node-positive patients with low ER expression?

For instance, ER/PR >1% but <10% and Ki67 >50%

How do you approach treatment in premenopausal patients who develop a contralateral HR+ breast cancer while already on tamoxifen and ovarian function suppression?

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+/...

How do you view the use of adjuvant CDK4/6 inhibitors overall given discordant results between MonarchE and PALLAS?

Are there factors to explain why MonarchE was a positive study and PALLAS was not?

How far can you dose reduce abemaciclib for a patient who is having toxicity at starting doses?

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

Will you offer adjuvant abemaciclib to breast cancer patients with high Ki-67 who are unable to receive perioperative chemo due to comorbidities or who decline chemotherapy?

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

Would you give anthracycline chemotherapy to a patient with HR+, HER2 negative inflammatory breast cancer who has history of cardiomyopathy with LVH and moderately reduced EF but most recent echo shows improvement to normal or near normal ejection fraction?

If no anthracycline, what alternative regimen would you consider?

Does the magnitude of benefit with 2 years of adjuvant abemaciclib outweigh side effects, given that many patients will receive CDK 4/6 inhibitors at breast cancer recurrence, precluding OS benefits?

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

Would you offer adjuvant abemaciclib + an aromatase inhibitor to a patient with a local HR+HER- breast cancer reoccurrence while on tamoxifen that meets high-risk criteria?

High-risk criteria meaning >4 positive nodes and Ki67 >20%

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?

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 PADA1 and EMERALD trials presented at SABCS 2021 impact your decision making?

Would you use OncoType Dx to guide adjuvant therapy recommendations in the context of locally recurrent, node-negative, ER+ breast cancer previously treated with endocrine therapy alone?

No oncotype was sent on the original breast cancer.

Will you recommend abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

With the recent announcement that the phase 3 MonarchE trial met its primary endpoint.

Do you need to wait for estradiol and FSH levels to normalize before you can switch from tamoxifen to an AI for a pre-menopausal woman with ER+ breast cancer?

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...

Does a very high Oncotype score influence your approach to adjuvant treatment in a patient with ER positive breast cancer?

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...

Is there a role for extended adjuvant neratinib with pCR after neoadjuvant chemotherapy in triple positive breast cancer?

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

Would you use aspirin 81 mg for VTE prophylaxis in patients on adjuvant tamoxifen/SERMs?

Is there data that it actually helps ?

Would you treat a postmenopausal women with high grade T2N0 ER-, PR+, HER2- invasive ductal carcinoma with upfront surgery or neoadjuvant chemotherapy?

ER <1%; PR 45%, Her2 negative by IHC and FISH. Grade 3, Ki67: 80%.

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.

In light of RxPonder results for postmenopausal women with early stage node positive HR+HER2- breast cancer, when is there a role for full axillary LN dissection to confirm degree of nodal involvement and when would sentinel LN evaluation be sufficient?

How would this affect adjuvant radiation plan in breast conservation therapy patients and mastectomy patients?

How would you manage adjuvant endocrine therapy for a postmenopausal patient with early stage HR+ breast CA who develops an ischemic CVA on an AI?

Presuming that work-up for cardioembolic sources is negative, how would you proceed?

Do you discontinue anti-hormonal therapy if a high-risk ER+ HER2- localized breast cancer patient develops blood clots on anti-hormonal therapy?

How would you approach a patient who is intolerant of AI and develops thrombosis while on SERM?

Would you consider using OncoType Dx testing in a patient with breast cancer if nodal evaluation is not performed?

No sentinel lymph node biopsy was performed

Would you use OncoType in a postmenopausal female with HR+/HER2- with LN involvement who clinically meets RxPONDER criteria of 1-3 LN to guide the use of neoadjuvant chemotherapy?

How would the use of Oncotype guide your management in the neoadjuvant setting?

Would you modify the dose of aromatase inhibitors or selective estrogen receptor modulators in patients who have a history of gastric bypass or other malabsorptive conditions/surgeries?

How would you manage a premenopausal female with cT2cN0 HR+/HER2-negative breast cancer who received neoadjuvant TC for high OncoType, had no pathologic response to therapy and upstaged to pT2N1 on surgery?

What adjuvant therapies would you recommend?

What endocrine therapy would you recommend for a perimenopausal female with a low risk Oncotype, HR+, HER2-negative, SLNB negative breast cancer who is clinically postmenopausal but with FSH, LH and estradiol that are not in the postmenopausal range?

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?

In cases in which Oncotype DX test is not available, how do you decide which patients with HR+ and Her2- breast cancer are candidates for adjuvant chemotherapy?

How would your management differ in pre- and post-menopausal females?

Would you recommend extended adjuvant endocrine therapy if a patient tolerated 5 years thus far but Breast Cancer Index (BCI) shows a high risk of recurrence with low likelihood of benefit from extended therapy?

6 Answers available

What adjuvant treatment (if any) would you recommend for a post-menopausal patient with a borderline T1b (0.5 cm) grade 2 ER+/PR+/HER2 negative invasive lobular breast CA after bilateral mastectomies?

How would you manage adjuvant therapy for a premenopausal female with a T1cN1mi breast IDC that is HR+ HER2 positive on biopsy, but HR+ HER2 negative on lumpectomy surgical specimen?

<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.)...

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?

Do you give chemotherapy to women with clinical features of high risk ER+ breast cancer, but a low Oncotype DX score?

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...

How would you treat HR positive, HER2 positive metastatic breast cancer in patients with a borderline or poor performance status?

How would you modify adjuvant therapy for a patient with ER+ HER2+ breast CA with no response to neoadjuvant TCHP and develops pneumonitis on adjuvant TDM-1?

Would you use trastuzumab/pertuzumab, trastuzumab followed by neratinib, or another strategy?

What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?

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

How would you manage a patient with early stage ER+ HER2+ breast CA who cannot receive definitive local therapy due to severe cardiopulmonary co-morbidities?

How would your plan differ if the patient could eventually receive mastectomy once co-morbidities improve?

Would you consider adjuvant capecitabine in a premenopausal patient with HR-positive inflammatory breast cancer who had residual disease after neoadjuvant chemotherapy?

Masuda et al., NEJM 2017

What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

What would you recommend as the next line treatment in a post-menopausal woman with hormone receptor positive, HER2 positive breast cancer, with progression on T-DM1 in combination with aromatase inhibitor?

Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?

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?

If neoadjuvant therapy is indicated for luminal A breast cancer, when do you decide to use chemotherapy versus endocrine therapy?

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

How do you manage adjuvant endocrine therapy for pre-menopausal women with locally advanced, weakly positive ER/PR, HER2 negative breast cancer?

Would a pCR to neoadjuvant chemotherapy change your management? (ER <5%, PR <5%)

For anatomic stage III ER/PR+ breast cancer treated upfront with surgery, how do you decide which adjuvant chemotherapy to offer?

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...

What is your approach to tamoxifen use in women who are unable to discontinue a strong CYP2D6 inhibitor and who are unable to use or tolerate an AI?

How long would you keep a patient on endocrine/dual anti HER-2 therapy after resection of a late (>5 years) oligometastatic recurrence of ER+ HER2+ breast CA?

For patients who remain NED for years, when would you feel it's appropriate to hold therapy?

How do recent RxPonder results affect your adjuvant therapy choice for premenopausal women with HR+/HER2 negative breast cancer with 1-3 positive LNs?

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)?

How do you manage endocrine therapy for a perimenopausal woman with ER+ breast CA?

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.&...

What is your neoadjuvant chemotherapy of choice in patients with ER+ breast CA who are receiving neoadjuvant therapy with goal to convert to BCS from mastectomy?

Would your decision for anthracycline change if the patient were elderly?

How would you manage an elderly patient with clinical stage IIIC ER positive breast cancer who refuses surgery, chemo and radiation treatment and willing to take only oral medications?

Do you give adjuvant chemotherapy/trastuzumab to a premenopausal woman with a pT1aN0 HR+, Her2+ breast cancer?

What are your recommendations for post-menopausal patients who would fit into RxPonder trial criteria (HR+/HER2- breast cancer, 1-3 positive LNs) and have already started on adjuvant chemotherapy?

Would you send Oncotype during chemotherapy if not sent already? Would you stop adjuvant chemotherapy if a prior Oncotype was 25 or less?

Would you give a HER2 targeted agent to a patient whose initial cancer was ER/PR positive, HER2 negative but now with metastatic disease that is ER positive, PR negative, HER2 2+, FISH equivocal?

Patient has progressed through prior lines of endocrine therapy.

How do the new RxPONDER results affect your choice of adjuvant therapy for postmenopausal women with HR+/HER2 negative breast cancer and 1-3 positive lymph nodes?

Would you send an Oncotype RS to determine the role of adjuvant chemotherapy and/or endocrine therapy?

Would you use a PARP inhibitor in metastatic ER/PR positive breast cancer with somatic BRCA1 mutation but negative for germline mutation?

How would you approach adjuvant therapy for a young post-menopausal woman with a grade 3 pT1a (5mm) node negative ER+/HER2- invasive ductal carcinoma?

Would you consider gene profiling to determine need for chemotherapy?

How would you approach diagnosis of residual ovarian tissue in a patient with ER positive breast cancer, history of BSO, and a rising estradiol level on tamoxifen?

Will you use ovarian function suppression in lieu of chemotherapy in premenopausal patients with pN1 ER+ HER2- breast CA with OncoType RS <25?

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

How would you manage a middle aged woman with history of severe alcoholic liver cirrhosis and a small node negative ER/PR positive, HER2 negative breast cancer?

How would you balance the competing risks of these two diagnoses in her treatment?

Would you recommend adjuvant T-DM1 or continue with trastuzumab +/- pertuzumab in addition to endocrine therapy for HER2+ and ER/PR+ breast cancer with ypT1mic residual disease after neoadjuvant TCHP?

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

Based on the results of MonarchE, would you offer adjuvant abemaciclib for HR+ patients who do not achieve pCR after neoadjuvant chemotherapy?

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

Are you more inclined to offer adjuvant chemotherapy for a post-menopausal woman after lumpectomy for a small TNBC who has a concurrent metastatic ER+ breast CA?

Any difference in recommendations if the patient was asymptomatic from her metastatic ER+ disease? (eg bone mets)

When would you offer ovarian suppression in addition to endocrine therapy for premenopausal women who omit adjuvant chemotherapy?

How do clinical risk and Mammaprint/Oncotype scores affect your decision?

Is there any role for alpelisib in a patient who has triple positive breast cancer and an activating PIK3CA mutation?

How would you counsel a patient with HR+, HER2- breast cancer with an OncotypeDx ROR score of 0 who is refusing endocrine therapy?

Would you treat an ER/PR+ inflammatory breast cancer that is HER2 2+ by IHC but 5% positive by FISH as HER2 positive?

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

What adjuvant therapy would you recommend for a premenopausal patient with ER/PR+, HER2 negative T2N0 breast cancer s/p mastectomy, low OncotypeDx score and in first trimester of pregnancy?

Would you offer adjuvant chemotherapy for 1-3 node positive HR+, HER2 negative breast cancer with Mammaprint low risk to a young, pre-menopausal patient?

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 do you manage a breast cancer patient with discordance in hormone receptor status with IHC and Oncotype?

Do you approach the treatment of post-lumpectomy DCIS which is only present within an intraductal papilloma differently, if it does not involve adjacent breast tissue?

What considerations do you take for post-lumpectomy radiation and endocrine therapy?

Would you offer adjuvant chemotherapy to a premenopausal patient with ER/PR+ breast cancer, nodal micrometastasis, low OncotypeDx score but also BRCA2 carrier?

How do you manage ovarian suppression for premenopausal patients with HR+/HER2 positive breast cancer?

Does lymph node positivity change your management?

How would you manage a premenopausal woman with a poorly differentiated pT2 HR+/HER2- breast cancer and 3/3 SLNs with ITCs?

Would you consider ALND and /or XRT to axilla?

How would you council a woman in her 50s with Stage I HR+/HER2- breast cancer with a high risk Mammaprint but intermediate OncotypeDx regarding adjuvant chemotherapy?

Do you consider adjuvant chemotherapy for older women >75 years of age, with HR+ invasive ductal carcinoma and 3 positive LN however intermediate risk recurrence scores?

Would you use a platinum containing regimen such as docetaxel + carboplatin for an aggressive ER+ breast cancer in a patient with a deleterious mutation in ATM?

Would you treat a premenopausal woman with T2N0 ER-, PR+ (15-20%), HER2- breast cancer with neoadjuvant chemotherapy like a triple negative breast cancer?

6 Answers available

Would you offer chemotherapy to a postmenopausal woman with microinvasive ER/PR positive, Her2 negative invasive ductal carcinoma with a single lymph node metastasis and insufficient tissue for Oncotype testing?

Does ER+ status impact your choice of neoadjuvant systemic therapy in premenopausal women with cT2N0 HER2+ breast cancer?

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

For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?

Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.

Is there a role for endocrine therapy alone in patients with metastatic HR+, HER2+ breast cancer after all HER2 directed therapies have been used?

How would you approach adjuvant systemic therapy for a pT3N0(i+) HR+/HER2 negative breast cancer with an intermediate oncotype in a post-menopausal woman?

How would you approach adjuvant endocrine therapy after excision of a hormone positive recurrence after mastectomy who finished 5 years of aromatase inhibitor for the same primary tumor?

What other chemotherapy would you consider in a patient with high-risk node positive ER+, HER2- disease that developed pulmonary toxicity to paclitaxel and refuses any more taxanes?

She had already completed ddAC and two cycles of paclitaxel before the reaction.

What second line treatment would you choose for a post menopausal woman with HR+ HER2+ metastatic breast cancer with low burden disease treated with first line aromatase inhibitor and trastuzumab?

Are pre-menopausal women on tamoxifen at risk for endometrial cancer?

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

Do you offer local treatment to the breast primary in patients with de novo oligometastatic hormone positive breast cancer?

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 ...

For a post-menopausal patient with a pT2N0 HR+/HER2- breast cancer at surgery after 4 months of neoadjuvant anastrozole with minimal clinical or pathologic response, would you utilize genomic testing to guide decision about adjuvant chemotherapy?

Would you test initial core biopsy (prior to neoadjuvant anastrozole) or surgical specimen? Any preference for Oncotype vs. Mammaprint?

When would you consider fulvestrant + alpelisib in a postmenopausal patient who has HR+, PIK3CA mutant, metastatic breast cancer instead of initial CDK4/6 inhibitor therapy?

How would you approach adjuvant treatment of an early stage HR+ HER2+ cancer if the patient had already been taking an aromatase inhibitor for a contra-lateral HR+ early stage breast cancer?

Interest in approach for elderly population especially

How do you approach continuing vs discontinuing ovarian suppression for high risk HR+ breast cancer when a patient becomes post-menopausal?

How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?

Would you recommend additional cytotoxic chemotherapy and/or switch her anti-Her therapy to T-DM1?

How do you approach recommending tamoxifen in a premenopausal woman with Li Fraumeni syndrome and early stage low risk ER+ breast cancer?

How do you counsel regarding uterine sarcoma risk?

What would you advise a breastfeeding woman with localized HR+ breast cancer in terms of risk of progression with breastfeeding prior to local therapy with surgery?

What timeframe would you suggest to stop breastfeeding? From affected breast or both breasts?

How would you treat a newly diagnosed male with metastatic HR+ breast cancer?

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

How would you approach systemic therapy for a postmenopausal female with metastatic ER+/HER2+ breast cancer (liver/bone) who achieved a CR for 5 years on trastuzumab/pertuzumab and exemestane, with continued asymptomatic brain progression?

Asymptomatic brain progression despite CNS surgery and SRS x2 over the past 2 years.

Can fulvestrant cause a tumor flare reaction in hormone receptor positive breast cancer?

How would you approach a patient who responded to CDK4/6 inhibitor/endocrine therapy combination for metastatic HR+,HER2- breast cancer who now has disease progression which is biopsy proven TNBC?

Progression was observed only in the breast and required palliative mastectomy (T4b TNBC)

How would you approach a postmenopausal woman with Stage I HR+,HER2- breast cancer who had a CVA while on tamoxifen?

In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?

Would you offer adjuvant therapy to a patient who underwent bilateral mastectomies for DCIS and was found to have isolated tumor cells on sentinel node biopsy?

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

How do you approach use of tamoxifen in premenopausal patients who developed ovarian cysts while on therapy?

For example- do you have experience using a LHRH agonist along with tamoxifen?

What pathologic response criteria do you use to determine the need for further adjuvant therapy in patients with breast cancer?

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

Would you consider adjuvant TDM-1 for a patient with HR+,HER2+ breast cancer with pCR in the breast but N1mic disease post neoaduvant chemotherapy?

N1mic - few isolated malignant cells in 1 axillary lymph node

What would you use as adjuvant endocrine therapy for a patient who developed an invasive, hormone receptor positive breast cancer while on raloxifene for almost a decade prior?

Out of curiosity, I did tumor testing, and she does not have an activating ESR1 mutation.

How would you approach a post-menopausal women with recurrent ER/PR+, HER2- breast cancer only in the axillary lymph nodes?

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

Would you consider using CDK 4/6 inhibitors in a patient with end stage renal disease (ESRD) along with an aromatase inhibitor?

If so, please describe your experience and dosing.

How do you approach discussion of adjuvant chemotherapy for a T1b (0.5 cm) hormone positive breast cancer with high risk features and an Oncotype Score of 31?

Would you consider OFS in a young patient (<35) with ER+ breast cancer who required chemotherapy and menses resumed years later while on tamoxifen?

If the cancer was also HER2+, would that influence your decision?

What is your strategy for a patient who develops an enlarging ipsilateral axillary lymph node shortly after undergoing mastectomy and ALND for a pT2N3 ER+/HER2+ right breast cancer?

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

What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?

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

How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?

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

Would you consider adding neoadjuvant endocrine therapy in a patient with HR+, HER2- breast cancer who has not clinically responded to neoadjuvant chemotherapy?

She has received 4 cycles of AC with no clinical response and is now pending completion with Taxol.

Would you choose neoadjuvant endocrine therapy for a low grade, node negative, ER/PR positive, breast cancer given delays in definitive surgery due to the COVID-19 pandemic?

Would your choice vary based on the patient's gender?

How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?

Would you consider delaying chemotherapy and proceeding only with endocrine for now?

How would you treat an elderly female with metastatic HR+,HER2- breast cancer on endocrine therapy who now has progressive bone only disease?

Initially treated with anastrozole, current treatment is with fulvestrant.

How would you approach a premenopausal woman with HR+, HER2- metastatic breast and a PIK3CA mutation?

How would you treat a patient with locally advanced HR+ breast cancer with contralateral axillary lymph node involvement?

No primary identified in the contralateral breast. No distant metastasis identified.

How would you treat a patient with HR+,HER2- metastatic breast cancer with a gBRCA mutation who has progressed on endocrine therapy with a new pericardial effusion?

How do you approach a pre-menopausal female with HR+ breast cancer with discordant IHC and OncotypeDx ER expression?

IHC: ER 70%; PR 70% OncotypeDx: ER - Negative; PR - Positive

How would you approach a patient with T3 HR+,HER2- breast cancer who had no clinical improvement after ddAC?

Do you proceed with Paclitaxel or go to surgery instead?

How do you approach recurrent, localized HR+, HER2- breast cancer in a patient who has progressed on exemestane (and previously on letrozole and tamoxifen)?

Would you use a NTRK TKI for a patient with metastatic HR+, HER2- breast cancer with a complex NTRK3 gene re-arrangement on Foundation testing?

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

Do you change systemic endocrine therapy for a patient who progresses only in the brain after SRS for metastatic HR+ breast cancer?

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)...

Would you offer neoadjuvant immunotherapy in addition to chemotherapy for locally advanced HR+ breast cancer based on the I-SPY 2 data?

How would you approach a postmenopausal female with localized ER+ breast cancer on adjuvant anastrozole with a rising estradiol level?

Pre-treatment estradiol: <5 Estradiol after 1 yr: 35

Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?

Would you use neoadjuvant CDK4/6 inhibitor and AI in HR+ breast cancer based upon the randomized phase II CORALLEEN trial?

https://www.ncbi.nlm.nih.gov/pubmed/31838010

In a patient with early stage HR+ breast cancer who was perimenopausal at diagnosis but intolerant of AI, would you consider extending tamoxifen beyond 10 years?

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...

What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?

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...

What do you recommend for women on AI therapy who experience excessive hair loss?

How would you treat a postmenopausal woman with recurrent, localized ER+,HER2- breast cancer to the contralateral breast while on AI?

In a patient with HR+HER2+ early breast cancer who is receiving adjuvant T-DM1 for residual disease, do you overlap endocrine therapy with T-DM1?

For premenopausal patients with early stage HR+ breast cancer for whom you are recommending tamoxifen, how do you select patients for extended endocrine therapy?

Are there clinical scenarios in which 5 years of tamoxifen alone remains sufficient?

Would a low or intermediate OncoType RS affect your choice of adjuvant endocrine therapy for a premenopausal woman with high clinical risk HR+ early stage disease?

Would you offer AI + OFS or tamoxifen to a woman with a grade 3 T2N0 tumor and OncoType of 15?

Would you offer additional therapy for a patient with HR+ breast cancer on AI+OS who is found to have a focus of ovarian metastasis at the time of elective BSO?

Additionally, would the finding of any mutations, such as ESR1, change your recommendation?

Does germline BRCA 1/2 mutation status impact your use of OncoType Dx for early stage ER positive breast cancers in post-menopausal women?

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?

Would you offer adjuvant HER 2 directed therapy for ER+/PR+/HER2+ pT1-T2 N0 papillary carcinoma of the breast?

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

What is your preferred chemotherapy regimen for patients with peripheral neuropathy and high risk HR+/HER2- breast cancer?

What factors influence whether you order OncotypeDx in HR+ node negative ILC?

Does a complete pathologic response to neoadjuvant chemotherapy affect the duration of endocrine therapy/OFS that you recommend for a premenopausal patient with HR+/Her2+ breast cancer?

How do you decide which patients need extended adjuvant endocrine therapy?

How would you approach a patient with metastatic ER/PR+,HER2- breast cancer with linear leptomeningeal enhancement on MRI but negative CSF protein and cytology?

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

How do you approach a post-menopausal female with early stage ER+,HER2+ breast cancer s/p lumpectomy with invasive ductal histology and lymph node involvement with invasive lobular histology?

Margins were negative and there was no evidence of LCIS or lobular component in the lumpectomy specimen. Role for possible mastectomy?

What adjuvant endocrine therapy would you recommend for patients who have undergone prior gastrectomy?

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

How would you approach a post-menopausal female with recurrent HR+, HER2- breast cancer with brain metastasis?

Prior localized HR+,HER2- breast cancer treated with adjuvant AC-T (5years ago) Recent ipsilateral axillary recurrence (HR-,HER2+) s/p neoadjuvant TC...

How would you approach a young patient with ER+/Her2- bilateral breast cancer with a solitary bone metastasis?

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

How would you approach a patient with ER+,HER2- T4N0 breast cancer with chest wall involvement?

Role of neoadjuvant TC vs. anthracycline based regimen?

How would you manage a postmenopausal female with a history of early stage invasive ductal ER+/HER2- breast cancer s/p mastectomy who has a local recurrence of ER+/Her2 - lobular carcinoma while on letrozole?

How would you approach a patient with metastatic ER+/Her2+ who has progressed on trastuzumab/pertuzumab + tamoxifen after being in remission for 4yrs?

What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?

How do you use neratinib in HR+ HER2+ patients in the adjuvant setting if patients got adjuvant T-DM1 for residual disease after neoadjuvant therapy?

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

Would you change treatment for denovo stage IV breast cancer Her 2 positive, ER positive in remission now with isolated brain metastasis?

The patient received THP and now is on maintenance HP when she developed CNS disease.

How would you treat a patient with a known history of ER/PR 90% and HER2 negative who develops skeletal metastatic disease on adjuvant endocrine therapy but now ER is only 2% and is PR and HER2 negative?

Initially stage 1 disease with high risk Mammaprint recurrence risk completed adjuvant chemo 15 months ago.

How would you treat a young patient with good performance status who has de novo metastatic HR+ Her2+ inflammatory breast cancer with asymptomatic leptomeningeal and CNS parenchymal disease?

Can you use Oncotype for determining adjuvant therapy in a young, premenopausal woman with multifocal HR+ breast cancer s/p mastectomy with 2 positive lymph nodes?

Is there a role for the neoadjuvant use of CDK 4/6 inhibitors with endocrine therapy in patients with well differentiated and/or invasive lobular histology who desire breast conservation?

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...

What is the role of neo-adjuvant chemotherapy in triple positive cT1c N0 breast cancer especially after recent data from KATHERINE trial?

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

How do you utilize CDK 4/6 inhibitors in metastatic ER+ HER2+ breast CA?

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

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

For example first-line ribociclib/letrozole, and second-line palbociclib/fulvestrant? Without data, would there be any expected benefit?

Is a tumor ever too small to send off a genomic assay like Oncotype or Mammoprint in HR positive, HER2 negative stage 1 breast cancer?

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...

Are Mammaprint and OncotypeDx as useful in stratifying risk in patients with early stage HR+, HER2 negative lobular carcinomas, as in those with ductal carcinomas?

Do you utilize genomic testing (oncotype, breast cancer index) in HR positive breast cancer to make recommendations regarding the duration of endocrine therapy?

In a patient with resected ER+ HER2- breast cancer, how do you decide between TC vs ddAC-T for adjuvant chemotherapy?

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?

What would you choose as second-line therapy in patients with ER/PR-positive, HER2-negative metastatic breast cancer progressing on first-line CDK 4/6 inhibitor/AI combination?

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