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Here to bring you updates on metastatic breast cancer, Dr. Sramila Aithal from US Oncology dives into an informative overview including all of the game-changing abstracts from ASCO22 you’ll need to know.

What has changed in early-stage breast cancer care? Dr. Allison Zibelli from Sidney Kimmel Cancer Center-Jefferson Health gives us an informative overview of new data that is sure to increase our knowledge of the latest in top-quality cancer care.

Here to bring you updates on metastatic breast cancer, Dr. Lee Schwartzberg from Renown Institute for Cancer dives into a summary including all of the game-changing abstracts from ASCO22 you’ll need to know.

What has changed in early-stage breast cancer care? Dr. Rebecca Shatsky from the University of California San Diego gives us an informative summary that is sure to increase our knowledge of the latest in top-quality cancer care.

What has changed in early-stage breast cancer care? Dr. Aixa Soyano from Moffitt Cancer Center gives us an informative summary that is sure to increase our knowledge of the latest in top-quality cancer care.

Here to bring you updates on metastatic breast cancer, Dr. Pooja Advani from Mayo Clinic gives us a summary of all of the game-changing abstracts from ASCO22 you’ll need to know.

Dr. Jane Meisel, breast cancer care expert from Emory University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. You have a 41yo female with ER+ (99%) PR + (26%) HER2 1+/FISH negative metastatic breast cancer that has progressed on palbociclib/letrozole (18 months), fulvestrant (six months), capecitabine (9 months), and is now interested in options for the next line of treatment.  She has progressed in the liver, lungs, and bone, but is minimally symptomatic with ECOG PS 1. Would you consider starting her on trastuzumab deruxtecan? 1. No, she would need to have more chemotherapy to have met the criteria for DESTINY-Breast 04 enrollment 2. Yes, because DESTINY-Breast 04 increased progression-free survival in patients like her (but not overall survival) 3. Yes, because DESTINY-Breast 04 increased progression-free and overall survival in patients like her   4. No, because Her2 low as defined in DESTINY-Breast 04 was defined only as Her2 2+/FISH negative   Answer: 3.  Patients needed only one line of chemo to qualify for enrollment in DESTINY-Breast 04 and could be HER2 1+ or 2+ to meet HER2-low criteria, hence A and D are incorrect. B is incorrect because in DESTINY-Breast 04, trastuzumab deruxtecan improved PFS and OS. Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Cynthia Ma, breast cancer care expert from Washington University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. A 78-year old woman presents to your clinic, s/p left mastectomy that removed a 3cm size, high grade, invasive ductal carcinoma. Sentinel lymph node biopsy found 2 of 3 positive lymph nodes (pT2N1). ER positive (Allred score 7), PR negative, HER2 1+ on IHC. Staging workup negative for distant metastasis. She has hypertension and diabetes, but well controlled. She does not exercise, but has no difficulty with activities of daily living and lives with her husband. Oncotype RS was found to be 33. Ki67 IHC MIB-1 pharmDx 30%. Her DEXA revealed T score -1.8 at lumbar spine. CARG chemo-toxicity score was 10. What is your recommendation regarding adjuvant therapy? Choose all that applies. a. Adjuvant chemotherapy with TC (Docetaxel plus cyclophosphamide) x b. Adjuvant aromatase inhibitor plus denosumab or zoledronic acid c. Consider adjuvant abemaciclib x 2 years d. Adjuvant radiation therapy to chest wall and draining lymph nodes e. All of the above f. b+d g. b+c+d h. other Answer: the correct answer is g. Rationale: The Cancer and Aging Research Group (CARG) score is a validated geriatric assessment model for adults greater than 65 yrs to predict the risk of grade 3-5 chemotherapy toxicity in the treatment of solid tumors. The CARG score, ranging from scores of 0 to 19, incorporates measures of functional status such as fall history, hearing problems, physical capabilities, performance status as well as objective measures including age, gender, height, weight, cancer type, type and dose of chemotherapy, hemoglobin, and creatinine clearance. CARG scores were stratified as low (score 0-5), intermediate (score 6-9) and high risk (score 10-19). Since the patient has a high risk CARG toxicity score, we would not recommend adjuvant chemotherapy. In the ASTER 70s Study, which randomized patients over 70s with ER+/HER2- breast cancer with high genomic grade index to receive endocrine therapy with or without chemo, found no overall survival benefit of adjuvant chemotherapy in the intent to treat population. After adjusting the 20% of patients randomized to therapy chemotherapy arm but did not go on chemotherapy, there was a 1.7% absolute benefit at 4 years from chemotherapy, although significant, but small. Adjuvant bisphosphonate is recommended in postmenopausal women with early stage breast cancer based on benefit in reducing bone metastasis and overall survival in meta-analysis. Denosumab is another option based on its efficacy in preventing recurrence observed in the ABCSG 18 trial. Find more oncology education opportunities at www.totalhealthconferencing.com