Triple negative   

Patient is BRCA 1/2 wild type; completed four cycle of Carbo/paclitaxel and two cycles of AC with pembrolizumab in the neoadjuvant setting.  

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

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

Would you proceed with KEYNOTE 522 regimen and add anti-HER2 targeted therapy adjuvantly?

What scenarios would you do second neoadjuvant treatment vs surgery?

If said patient was known to be gBRCA mutated, would you use neoadjuvant chemotherapy to enable adjuvant olaparib for those that did not have a pCR? &...

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

Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence? 

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

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

Does not meet Olympia trial indication

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

Given sacituzumab is an antibody drug conjugate of the active metabolite of irinotecan

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

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

This situation can feel uncomfortable.  Would this feel safer if patient is s/p mastectomy and had TNBC?

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

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

CNS recurrence occurred within two years of prior neoadjuvant therapy

Will you incorporate carboplatin into the backbone as it was done in the KEYNOTE trial?

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 ...

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

Based on pCR and EFS data from KEYNOTE 522 and recent FDA approval?

Given that olaparib was given within 12 weeks of completion of standard adjuvant therapy on the trial, will you still offer it to patients outside tha...

In patients who have completed all adjuvant therapy. Similar test to what is available for stage 2 and 3 colon cancer patients by Natera.

Healthy 67 y/o woman, 1.5cm tumor, grade 3

Patient was given ddAC + T

Presuming that imaging does not show distant metastatic disease, what would you offer? What about if the patient were PD-L1 negative?

Do you have any experience with intra-pericardial chemotherapy administration, and if so, in what cases?

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

Would you finish up pembrolizumab, give capecitabine, or both?

Patient underwent an axillary dissection with ITCs in 1/23 nodes.

Given that trials excluded patients with low ER, PR for this approach. 

What factors would determine your consideration of this as a recurrence versus a new primary and how would that influence your decision?

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

Would it affect your decision whether original primary tumor and treatment was hormone positive or negative?

Options: 1) ddAC-T- surgery- adjuvant capecitabine if residual disease 2) weekly taxol/carbo x 12 followed by dd AC x 4 3) Keynote 522- pembro/taxo...

For example: do you use docetaxel + cyclophosphamide (TC) x4 and what is the evidence for using such a regimen

surgically confirmed node negative disease 

BRCA status unknown currently 

Would you consider use of immunotherapy with checking PDL1? What chemotherapy agents would you consider along with mastectomy/radiation?

Chemotherapy - Carbo/Gem (2nd line). PDL1 and BRCA negative. 

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

Patient completed adjuvant AC-T 8 months prior to recurrence. BRCA negative, foundation medicine NGS pending. 

PD-L1 is low and she has residual neuropathy from neoadjuvant paclitaxel.

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

Would you consider still immunotherapy even if aggressive disease vs single agent chemotherapy?

Does the SYSUCC-001 trial presented at ASCO 2020 change your practice?

Patient previously received neoadjuvant carboplatin, anthracycline and taxane regimen and is BRCA negative.

How does gBRCA status impact your decision?

Would you incorporate platinum into your treatment or enroll in an adjuvant IO trial? 

History of Multiple Myeloma with renal failure currently on velcade.

2D Echo - Normal Ejection Fraction 

PDL1 status pending; BRCA wild type

Does the results of the tnAcity trial influence your decision in choosing a 1st line option?

Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...

Following SRS to the brain lesions, is it safe to closely follow the patient for recurrence?

Why do the NCCN guidelines suggest using neoadjuvant therapy only for patients with T2 or greater tumors?

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

The patient was previously treated with TAC x 6 (cumulative Adriamycin dose of 300 mg/m2) for a triple negative breast cancer. Would you consider inco...

As expected triple negative.

Are you using post-neoadjuvant Xeloda based on preliminary data from the CREATE-X trial? Does BRCA mutation influence your decision?

If so, what regimen? 

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

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