MD Anderson   

Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT

Previously untreated

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

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

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

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

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

At what frequency and for how long should echos be monitored?

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?

What is your specific therapy choice and duration?

 Would you consider gene profiling to determine need for chemotherapy?

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, if a patient had testosterone pellets injected, perhaps making endocrine therapy less efficacious, would that sway you to use chemo?

Do your recommendations differ if patients are pre or postmenopausal given the data?

How applicable is the SOFT/TEXT data in this setting ?

In the setting of the recent TailorRx data, would these patients be considered more high risk?

How often will you monitor it? In the setting that patient is morbidly obese, does your strategy change?

I.e. either for treatment of high-risk disease or intolerance/contraindication to tamoxifen. Will you continue it for the full 5 year course?

Do you prefer doing this through a "neoadjuvant" approach vs. post-operatively? CALOR trial

In a patient with isolated leptomeningeal disease (no systemic disease), would you still recommend systemic therapy?

Do you reserve this approach for only women with triple negative breast cancer or all-comers?

At what point do you send these test, and in what instances do the results influence your treatment recommendations?