eCase - HR-Positive HER2-Negative BC

Introduction

In this activity, Joyce O’Shaughnessy, MD, reviews the latest clinical data supporting state-of-the-art treatment of patients with high-risk hormone receptor (HR)‒positive/HER2-negative breast cancer, including new approvals and emerging agents under investigation that are likely to change the treatment landscape.

Please note that the slide thumbnails in this activity link to the PowerPoint slideset associated with this program, which also can be found here. The slideset can be downloaded by clicking on any of the thumbnails within the activity.

Clinical Care Options plans to measure the educational impact of this activity. Some questions will be asked twice: once at the beginning of the activity, and once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your individual responses will not be shared. Thank you in advance for helping us assess the impact of this education.

Before continuing with this educational activity, please take a moment to answer the following questions.

If you are a healthcare professional (HCP) providing patient care, how many patients with breast cancer do you see in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20

Which of the following can help you assess high-risk status and inform optimal adjuvant therapy for a patient with newly diagnosed HR-positive/HER2-negative early breast cancer (EBC)?

A.
High BMI, postmenopausal, with ESR1 gene mutation
B.
Premenopausal, tumor size of 3 cm, and Ki-67 of 10%
C.
Premenopausal and 21-gene panel recurrence score of 20
D.
Progesterone receptor (PgR) negative, Ki-67 score of 5% following preoperative endocrine therapy
E.
Tumor size of 5 cm and 4 positive axillary lymph nodes

A 58-year-old woman who is postmenopausal presents with a 5-cm right breast mass with a suspicious axillary lymph node. Initial breast biopsy reveals invasive ductal carcinoma, grade 2; estrogen receptor (ER) 80%, PgR 30%, and HER2-negative by immunohistochemistry (IHC). Fine-needle aspiration of a palpable right axillary lymph node reveals carcinoma. Panel germline testing is negative for a deleterious mutation. Patient receives neoadjuvant doxorubicin, cyclophosphamide, and paclitaxel followed by bilateral mastectomy. Right mastectomy specimen reveals a 3-cm invasive ductal carcinoma with minimal chemotherapy effect and 4/15 positive nodes. Patient returns to the clinic now to discuss adjuvant treatment options.

Based on tumor characteristics and predictive biomarkers, which of the following would you select as adjuvant therapy for this patient?

A.
Aromatase inhibitor (AI)
B.
AI + abemaciclib
C.
Nonsteroidal aromatase inhibitor (NSAI) plus ribociclib
D.
AI + palbociclib
E.
AI + olaparib

A 73-year-old woman is diagnosed with de novo stage IV ER-positive, PgR-positive, HER2-negative metastatic breast cancer (MBC) with liver and bone metastasis; breast and liver biopsies show ER 90%, PgR 90%, HER2 1+, fluorescence in situ hybridization (FISH) negative invasive ductal carcinoma. Her medical history includes hypertension and Bell’s palsy. Smoking history (10 pack-year) but quit 30 years ago. Family history: 2 sisters with breast cancer, mother, and brother with colon cancer. Current biomarker testing status: BRCA1/2 and PALB2 wild-type. She previously received ribociclib plus AI, and after 34 months of therapy, the patient developed progressive disease in her bones with stable residual disease in her liver. Additional biomarker testing now reveals an activating ESR1 mutation.

Which therapy would you recommend next for this patient?

A.
Alpelisib plus fulvestrant
B.
Chemotherapy
C.
Capivasertib plus fulvestrant
D.
Elacestrant
E.
Switch to a different ET and CDK4/6 inhibitor
F.
Trastuzumab deruxtecan (T-DXd)

A 57-year-old postmenopausal woman presents with a 7-cm left breast mass and a suspicious 5-cm mass in the liver and no other visceral involvement. Breast and liver biopsies reveal invasive ductal cancer, ER 100%, PgR 60%, HER2-negative by IHC; Ki-67 30%; gBRCA status is currently unknown.

Which of the following would you select as the optimal therapy for this de novo MBC based on tumor characteristics and the latest guideline recommendations?

A.
AI or fulvestrant with a CDK4/6 inhibitor
B.
AI plus alpelisib
C.
AI only
D.
Chemotherapy plus pembrolizumab
E.
Chemotherapy
F.
Elacestrant
G.
Sacituzumab govitecan
H.
T-DXd

Which of the following would you recommend to your patients with early-stage HR-positive/HER2-negative breast cancer who are currently receiving an oral targeted therapy, to improve adherence to therapy?

A.
Ask them to see you every 2 weeks for the first 2 months to confirm they are taking their therapy
B.
Tell patients to consider a low-fiber and low-fat diet to reduce risk of diarrhea
C.
Recommend to patients to take their medication at the same time and place in an area they use every day
D.
Ask open questions about their anxiety status, fatigue status, and other quality-of-life considerations

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Improving Outcomes in Patients With High-Risk Breast Cancer: Expert Guidance and Team Training for HR-Positive/HER2-Negative Disease

Joyce O'Shaughnessy, MD

Activity