Breast Cancer, Metastatic&nbsp;&nbsp;&nbsp;

Do you continue endocrine therapy for women with HER2+/HR+ metastatic breast cancer when starting a HER2-directed antibody-drug-conjugate?

For patients with stage IV triple negative breast cancer with a prolonged complete response to therapy and who are tolerating therapy well, how do you approach continuation vs cessation of therapy?

Do you recommend maintenance immunotherapy after CR on chemotherapy for patients with metastatic TNBC?

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

What are your top takeaways in Breast Cancer from ASCO 2022?

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

12 Answers available

When, if ever, will you utilize T-DM1 in metastatic HER2+ breast cancer given trastuzumab deruxtecan's significantly improved PFS vs T-DM1?

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...

How would you approach a young patient with oligometastatic inflammatory triple negative breast cancer with bone only metastases?

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

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?

Would you use T-DXd or capecitabine/trastuzumab/tucatinib for HER2+ metastatic breast cancer with predominantly CNS progression after THP?

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

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

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

When do you consider HER2-targeting antibody drug conjugates in the first line setting for metastatic HER2 positive, ER negative breast cancer?

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...

Would you recommend olaparib for a patient with germline BRCA1 mutation and HER2+ metastatic breast cancer who has progressed through multiple lines of HER2-directed therapy including trastuzumab deruxtecan?

4 Answers available

How would you manage tucatinib-associated grade 2 indirect hyperbilirubinemia in a patient with metastatic HER2-positive breast cancer involving the CNS is receiving trastuzumab + capecitabine + tucatinib?

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

Would a HER2 mutation on NGS of a biopsy of a breast cancer liver metastasis change your management if the met is HER2- by IHC with the initial localized disease being HER2+?

If NGS was positive would you treat with HER2 directed therapy? Is this a different clone and should be treated as such?

In a patient with metastatic HER2 positive breast cancer who has received prior TDM1 in the adjuvant setting for residual disease, would you consider reintroduction of TDM1?

The patient is intolerant to trastuzumab deruxtecan. In which clinical settings would you consider reintroduction of TDM1?

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?

In metastatic TNBC with a germline or somatic BRCA mutation, when is the preferred time to introduce a PARP inhibitor?

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

How do you address and mitigate neutropenia in patients with TNBC receiving sacituzumab govitecan in 3rd line or beyond?

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...

4 Answers available

In which scenarios would you utilize sacituzumab govitecan earlier than third line in the treatment of metastatic TNBC?

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

4 Answers available

How has the ASCENT trial impacted your management of previously treated metastatic TNBC?

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

Are there known biomarkers predictive of response or resistance to sacituzumab govitecan which should be incorporated into treatment decisions for metastatic TNBC?

Are there differences in outcome among the BRCA mutated subgroup, or others?

What is the preferred sequence of systemic therapy in a patient with endocrine resistant HR+ metastatic breast cancer?

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

How do you counsel patients with metastatic TNBC on their various treatment options after progression on first line regimens?

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

For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?

CNS recurrence occurred within two years of prior neoadjuvant therapy

Would you consider a CDK 4/6 inhibitor in combination with endocrine therapy for a patient with ER low (1-9%) metastatic breast cancer?

In which situations would you consider this a reasonable treatment option?

Would you consider use of PARP inhibitors in patients with metastatic breast cancer with moderate penetrance germline mutations such as CHEK2, ATM, RAD51?

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...

How do you treat leptomeningeal disease in metastatic HR+ HER2- breast cancer?

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

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

Would you consider a treatment holiday in a patient with HR+ oligometastatic breast cancer who is in a prolonged remission?

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...

With advancing and new therapies emerging for metastatic HER2+ breast cancer, how does one decide between options for third line therapy at time of progression?

How do you treat metastatic HER2 positive breast cancer in a patient with hepatic visceral crisis?

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

For patients with metastatic triple negative breast cancer on nab-paclitaxel + atezolizumab who have an ongoing response, are you continuing immunotherapy after the FDA withdrawal of atezolizumab?

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 a patient with metastatic TNBC on chemoimmunotherapy for several years and a near complete response, would you consider an immunotherapy holiday?

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 ...

Would you consider surgical management of a TNBC primary after a patient has had radiographic resolution of oligometastatic disease?

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

How do you approach the treatment of de novo, brain only metastatic HER2 positive breast cancer?

Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?

Do any studies support this rationale? Does the presence of a somatic vs germline BRCA mutation impact your decision?

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?

What is your preferred bone modifying agent and frequency of dosing in patients with breast cancer and bony metastases?

Do you discuss patient visits and associated costs when making this decision?

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?