Adjuvant Therapy for HR+HER2- Early Breast Cancer

CE / CME

Selecting Adjuvant Therapy for Patients With HR+/HER2- Early Breast Cancer at High Risk of Recurrence
Credits Available

Physician Assistants/Physician Associates: 0.25 AAPA Category 1 CME credit

Nurses: 0.25 Nursing contact hour

Pharmacists: 0.25 contact hour (0.025 CEUs)

Physicians: maximum of 0.25 AMA PRA Category 1 Credit

ABIM MOC: maximum of 0.25 Medical Knowledge MOC point

Released: September 16, 2024

Expiration: September 15, 2025

Pretest

Progress
1 2 3
Course Completed
Please answer the questions below.
1.

How confident are you at assessing risk in patients with HR-positive/HER2-negative early-stage breast cancer to guide adjuvant therapy selection? 

2.

Case: A 54-Yr-Old Postmenopausal Woman With Newly Diagnosed HR+/HER2- EBC



  • A 54-yr-old woman who is postmenopausal is newly diagnosed with HR+/HER2- EBC

    • Biopsy of 3-cm breast mass reveals grade 3 IDC and FNA of suspicious axillary LN is positive

    • ER: 80%, PgR: 30%, HER2: IHC 0

    • Ki-67: 15%

    • gBRCA1/2 testing: negative



  • Patient underwent a lumpectomy with ALN dissection

    • Surgical pathology demonstrates 2/15 positive right ALNs

    • Oncotype DX revealed an RS of 21



When planning adjuvant treatment with this patient, which of the following would you recommend based on the latest clinical data and guidelines?

3.

Case Continued: Diarrhea With Abemaciclib



  • The 54-yr-old woman with HR+/HER2- EBC initiates AI + abemaciclib at 150 mg PO BID

  • 6 days after starting her therapy, she calls the clinic and reports new-onset diarrhea (4 BM/day over baseline; grade 2)

    • The triage nurse recommends starting loperamide and continuing abemaciclib for now, but advises her to call back if the diarrhea does not improve



  • 2 wk after starting therapy, she comes in to have her labs drawn

    • When asked directly, she shares that the diarrhea worsened despite taking loperamide as prescribed

    • She is now having 5 BM/day over baseline (grade 2) despite taking loperamide



Which of the following strategies would you recommend to best manage this patient’s recurrent, persistent grade 2 diarrhea?