Nov 4, 2019

Breast Cancer Update for Surgeons, Issue 1, 2019 — Part #2: Our interview with Dr King highlights the following topics as well as cases from her practice:

• Recent developments in the surgical care of patients with breast cancer (00:0s
• Predictive versus prognostic role of the 21-gene assay RS in ER-positive, HER2-negative, node-positive breast cancer (01:45)
• Clinical implications of the TAILORx trial results (05:11)
• Reliability of the 21-gene assay RS in guiding neoadjuvant therapy decision-making (07:19)
• Impact of genomic assay testing and clinical features on the use of chemotherapy after the implementation of standardized reflex testing criteria  (10:39)
• Clinical utility of the 21-gene assay RS in the selection of therapy  (15:34)
• Application and utility of the MINDACT trial results; use of the 70-gene signature assay in breast cancer  (17:48)
• Criteria for surgeon-initiated reflex gene-expression profile testing for patients with early-stage breast cancer to reduce delays in the initiation of chemotherapy  (19:26)
• Surgeon variability and factors predicting the need for reoperation after breast-conserving surgery (24:22)
• Recent trends in reoperation after initial lumpectomy for patients with breast cancer (26:45)
• Multidisciplinary management of the axilla for patients with breast cancer undergoing primary mastectomy (28:25)
• Optimal locoregional management of sentinel node-negative and node-positive breast cancer (31:54)
• Key issues regarding gross and microscopic evaluation of breast and lymph node specimens after neoadjuvant systemic therapy (36:36)
• Importance of accurate specimen evaluation in assessing treatment response (39:15)
• Factors predicting the use of preoperative therapy for young women with breast cancer; impact on breast-conserving surgery (41:55)
• Updated AJCC Staging Manual: Incorporation of tumor biology into breast cancer staging to tailor treatment and refine prognosis (43:46)
• Case: A woman in her mid-40s with ER/PR-negative, HER2-positive IDC receives neoadjuvant paclitaxel/trastuzumab/pertuzumab on the Phase I DAPHNe trial (47:22)
• Perspective on the results of the KATHERINE trial (52:52)
• Threshold for neoadjuvant therapy in triple-negative versus HER2-positive breast cancer; side-effect profile of paclitaxel in combination with trastuzumab and pertuzumab (54:51)
• Case: A woman in her mid-30s with triple-negative breast cancer has residual invasive disease in the breast and axillary lymph nodes after receiving neoadjuvant dose-dense AC followed by paclitaxel (56:49)
• Perspective on the importance of genomic testing in guiding treatment decision-making for patients with newly diagnosed disease (1:01:7s
• Surgical treatment options for patients with triple-negative breast cancer and germline BRCA mutations (1:03:20)
• Case: A woman in her mid-40s with ER/PR-positive, HER2-negative IDC receives a RS of 18 (1:05:37)
• Effects of age, menopausal status and RS on the prediction of benefit from chemotherapy (1:08:14)

CME information and select publications