Topics:
Breast Cancer • Medical Oncology • MD Anderson • NCI-CCC Tumor Board Question • Her2+ • HR+ • NCI-CCC Breast Tumor Board Question
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.
Answer from: Medical Oncologist at Academic Institution
The benefit for TDM1 was seen in the subset analysis of KATHERINE patients with residual tumors under 1cm (including T1mic) HR .66 and about a 5% absolute risk reduction. So I agree with @Robert Wesolowski that switching to TDM1 should be discussed with the patient.
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Answer from: Medical Oncologist at Academic Institution
This is a very tough question. The KATHERINE trial allowed patients with any residual disease following neo-adjuvant chemotherapy. Based on analysis by Symmans et al., patients with HER2 positive breast cancer who had residual cancer burden (RCB) class I (minimal residual disease) had a 10-year...
Comments
Medical Oncologist at Joliet Oncology Hematology Associates
I agree that we need to discuss with the patients ...
I agree that we need to discuss with the patients ...
Medical Oncologist at Clinical Instructor
The issue of not having data when using T-DM1 in a...
The issue of not having data when using T-DM1 in a...
Medical Oncologist at University of Texas MD Anderson Cancer Center
There is no additional benefit of adding pertuzuma...
There is no additional benefit of adding pertuzuma...
Medical Oncologist at Warren Alpert Medical School of Brown University
I agree with @Vicente Valero. I would not expose t...
I agree with @Vicente Valero. I would not expose t...
Answer from: Medical Oncologist at Community Practice
I agree with the responses above. In the KATHERINE trial, the benefit was seen with T-DM1 among ypT1a, ypT1b, and ypT1mic patients who consisted of at least 40-44% of the cohort (for the intervention and the control groups, suggesting the benefit across all groups). Given this data, one will be incl...
Answer from: Medical Oncologist at Community Practice
Yes, for only microscopic residual disease, node-negative. We need more data in the future.