Agenda Module 1: her2-Positive Breast Cancer



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Agenda

  • Module 1: HER2-Positive Breast Cancer

    • CLEOPATRA, TEACH, APHINITY, others
  • Module 2: Multigene/Biomarker Assays

  • Module 3: Advanced ER-Positive Disease

    • SWOG-S0226, BOLERO-2, others
  • Module 4: HER2-Negative, BRCA1/2 Mutant

    • PARP inhibitors
    • Other chemotherapy ± biologics
  • Module 5: Bone-Targeted Therapy

    • NSABP-B-34, ABCSG-12 update, denosumab, others






Pertuzumab and Trastuzumab: Complementary Mechanisms of Action





CLEOPATRA: Efficacy Endpoints



















TEACH Study Design



Survival Analysis: ITT and Centrally Confirmed FISH+ (Median F/U: 4 Years)



Common Adverse Events: Maximum NCI CTC Toxicity Grades





Efficacy Analysis and Adverse Events





Efficacy Endpoints



PFS According to Baseline Plasma VEGF-A



A 42-year-old premenopausal woman presents 1 year after completing adjuvant TCH for ER-negative, HER2-positive IDC with asymptomatic lung mets. Your likely recommendation:



A 42-year-old premenopausal woman presents 1 year after completing adjuvant TCH for an ER-negative, HER2-positive IDC with asymptomatic lung mets. Your likely recommendation:



A 42-year-old premenopausal woman with an ER-positive, HER2-positive tumor presents 1 year after completing adjuvant TCH, on tamoxifen with asymptomatic lung mets. Your likely recommendation:



A 42-year-old premenopausal woman with an ER-positive, HER2-positive tumor presents 1 year after completing adjuvant TCH, on tamoxifen with asymptomatic lung mets. Your likely recommendation:







Methods for DCIS Score Validation Study



10-Year IBE Outcomes with the New Oncotype DX DCIS Score









Summary

  • 366 evaluable German patients with N0 and N+ (1-3 positive nodes) early breast cancer and no contraindication to chemo.

  • Physician recommendations assessed before and after Oncotype DX assay.

  • Initial treatment recommendation changed in 33.1% of all cases:

    • 30.3% in N0 disease
    • 38.5% in N+ disease
  • Treatment recommendations predominantly changed from chemoendocrine therapy to endocrine therapy alone:

    • 18.4% in N0 disease
    • 27.9% in N+ disease


About how many patients, if any, do you have in your practice with metastatic disease who had DCIS as their original diagnosis?



About how many patients, if any, do you have in your practice with metastatic disease who had DCIS as their original diagnosis?



For how many patients with node-positive disease in your practice have you ordered an Oncotype DX assay?



For how many patients with node-positive disease in your practice have you ordered an Oncotype DX assay?

















Mechanism of Action of mTOR Inhibitors



Crosstalk between ER and mTOR Signaling











A 64-year-old woman has a 2-cm ER-positive, HER2-negative primary breast cancer and asymptomatic bone and nodal mets. What systemic treatment would you recommend (cost and reimbursement aside)?



A 64-year-old woman has a 2-cm ER-positive, HER2-negative primary breast cancer and asymptomatic bone and nodal mets. What systemic treatment would you recommend (cost and reimbursement aside)?



A 64-year-old woman has ER-positive, HER2-negative asymptomatic bone and nodal mets during year 4 of adjuvant anastrozole. What would you recommend (cost and reimbursement aside)?



A 64-year-old woman has ER-positive, HER2-negative asymptomatic bone and nodal mets during year 4 of adjuvant anastrozole. What would you recommend (cost and reimbursement aside)?

















A 55-year-old woman with a node-negative, triple-negative IDC receives adjuvant docetaxel/cyclophosphamide (TC) but then develops asymptomatic bone and nodal mets 18 months later. What is your preferred treatment?



A 55-year-old woman with a node-negative, triple-negative IDC receives adjuvant docetaxel/cyclophosphamide (TC) but then develops asymptomatic bone and nodal mets 18 months later. What is your preferred treatment?



When using nab paclitaxel, what dose and regimen do you use?



When using nab paclitaxel, what dose and regimen do you use?



In the next 5 years, how likely is it that PARP inhibitors will become incorporated into the management of breast cancer?



In the next 5 years, how likely is it that PARP inhibitors will become incorporated into the management of breast cancer?



























A 42-year-old premenopausal woman has a node-negative, ER-positive, HER2-negative IDC with a low Recurrence Score (RS). The patient is receiving tamoxifen and has normal bone density. Would you add a bisphosphonate?



A 42-year-old premenopausal woman has a node-negative, ER-positive, HER2-negative IDC with a low Recurrence Score (RS). The patient is receiving tamoxifen and has normal bone density. Would you add a bisphosphonate?



A 62-year-old woman has a node-negative, ER-positive, HER2-negative IDC with a low RS. The patient is receiving an AI and has normal bone density. Would you add a bisphosphonate?



A 62-year-old woman has a node-negative, ER-positive, HER2-negative IDC with a low RS. The patient is receiving an AI and has normal bone density. Would you add a bisphosphonate?





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