Nov 4, 2019

Breast Cancer Update for Surgeons, Issue 1, 2019 — Part #1: Our interview with Dr Geyer highlights the following topics as well as cases from his practice:

• Case: A premenopausal woman in her mid-40s with Grade II, ER/PR-positive, HER2-negative lobular breast cancer, a 21-gene assay Recurrence Score (RS) of 10 and a deleterious CHEK2 mutation undergoes a bilateral mastectomy (00:00)
• Impact of gene-expression assay results on therapeutic decision-making  (04:54)
• Results of the Phase III TAILORx trial evaluating chemoendocrine therapy versus endocrine therapy alone for patients with ER-positive, HER2-negative, node-negative breast cancer and an intermediate RS (07:00)
• Clinical utility of the 21-gene and 70-gene assays (12:29)
• Benefit with the addition of ovarian function suppression to endocrine therapy for premenopausal women with ER-positive breast cancer at high risk for recurrence (14:11)
• Approach to assessing the adequacy of ovarian function suppression in premenopausal patients receiving aromatase inhibition (17:01)
• Significance of clinical risk category in prognosis and in the prediction of chemotherapy benefit by age and RS in the TAILORx trial (19:04)
• Use of adjuvant bone-modifying agents to reduce the risk of aromatase inhibitor-associated bone loss and fracture (24:51)
• Role of the 21-gene assay RS in guiding neoadjuvant therapy decision-making for ER-positive, HER2-negative localized breast cancer (27:39)
• Mechanism of action, efficacy and tolerability of CDK4/6 inhibitors for ER-positive, HER2-negative metastatic breast cancer (31:33)
• Investigation of CDK4/6 inhibitors alone or in combination with endocrine therapy in the neoadjuvant and adjuvant settings (36:00)
• Case: A postmenopausal woman in her mid-50s with Grade I, ER-positive, PR-negative, HER2-negative infiltrating ductal carcinoma (IDC) with 1 positive node and a RS of 20 receives an aromatase inhibitor and denosumab (39:49)
• Approach to the selection of adjuvant endocrine therapy; management of aromatase inhibitor-associated arthralgias (43:33)
• Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer (46:22)
• Prospective data with and ongoing evaluation of the 21-gene and 70-gene assays for patients with node-positive disease (49:23)
• Results from the Phase III KATHERINE study evaluating adjuvant T-DM1 versus trastuzumab for patients with HER2-positive localized breast cancer and residual disease after neoadjuvant treatment (54:20)
• Rationale for the design and entry criteria of the KATHERINE study (58:18)
• Mechanism of action, activity and tolerability of antibody-drug conjugates (1:02:46)
• Second opinion: Therapeutic options for a patient in her mid-40s with recurrent, locally advanced, ER/PR-positive, HER2-positive breast cancer (1:06:23)
• Clinical implications of the KATHERINE trial results (1:14:53)

CME information and select publications