eCase - MBC Applying New Developments

Introduction

In this activity, Joyce O’Shaughnessy, MD, reviews the latest data supporting state-of-the-art treatment for patients with metastatic breast cancer (MBC) and discusses new clinical trials likely to change the future treatment landscape for MBC.

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 specific 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 providing patient care, how many patients with advanced/metastatic breast cancer do you see in a typical month?

A.
1-4
B.
5-10
C.
11-15
D.
16-20
E.
>20
F.
Not applicable

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. Fine-needle aspiration of left axillary lymph nodes confirms presence of breast cancer in ≥4 lymph nodes. Patient proceeds with bilateral mastectomy, and liver biopsy reveals MBC. Pathology report indicates estrogen receptor (ER) 100%, progesterone receptor (PgR) 60%, HER2 negative by immunohistochemistry (IHC); ESR1 mutated; Ki-67 29%; BRCA and PD-L1 combined positive score (CPS) unknown.

Which of the following would you select as the optimal therapy based on tumor characteristics and the latest guideline recommendations?

A.
Aromatase inhibitor (AI) only
B.
AI plus alpelisib
C.
AI or fulvestrant with or without CDK4/6 inhibitor
D.
Chemotherapy plus pembrolizumab
E.
Chemotherapy with or without PARP inhibitor
F.
Elacestrant
G.
Sacituzumab govitecan
H.
Trastuzumab deruxtecan (T-DXd)

Your 75-year-old patient with early triple-negative breast cancer (TNBC) received neoadjuvant chemotherapy followed by surgery for localized disease 1 year ago. She now presents with what appears to be metastatic disease progression in the lungs and hip bones leading to a small fracture. Biopsy confirms recurrent metastatic TNBC.

Based on clinical evidence and expert recommendations, which of the following biomarkers can help determine the optimal next line of therapy for this patient?

A.
BRCA1/2 mutation
B.
HER2 expression by IHC
C.
HER2 mutation status
D.
PD-L1 CPS score
E.
PD-L1 CPS score and BRCA1/2 mutation
F.
PD-L1 CPS score and HER2 expression by IHC
G.
PD-L1 CPS score, BRCA1/2 mutation, and HER2 status by IHC
H.
Uncertain

The ongoing phase III CAPItello-291 trial is evaluating capivasertib plus fulvestrant vs fulvestrant with placebo in men and postmenopausal women with HR-positive/HER2-negative advanced breast cancer (ABC) who had disease recurrence on or after fewer than 12 months from end of AI therapy or after prior AI therapy for advanced disease. Which of the following statements is most accurate regarding the progression-free survival (PFS) outcomes in this trial?

A.
No PFS improvement
B.
Improvement only in AKT pathway–altered population
C.
Improved PFS in both overall and AKT pathway–altered population
D.
No benefit after previous CDK4/6 inhibitor or with liver metastases
E.
Uncertain

Your patient is a 49-year-old postmenopausal woman with history of metastatic TNBC with progression on several chemotherapy regimens, including together with immunotherapy. She is now receiving sacituzumab govitecan to manage her progressive disease and is tolerating it well. However, on cycle 3, Day 8, laboratory assessments show a marked decrease in absolute neutrophil count (ANC) to 500/µL.

In addition to initiating granulocyte colony-stimulating factor (G-CSF), which of the following evidence-based approaches would be most appropriate to manage this patient’s grade 4 neutropenia while she is receiving sacituzumab govitecan?

A.
Continue drug at the same dose, as this adverse event (AE) is expected to be transient
B.
Hold drug until ANC recovery, and restart at the same dose
C.
Hold drug until ANC recovery, and then restart at a 25% dose reduction
D.
Hold drug until ANC recovery, restart at a reduced dose of 50%, and send for UGT1A1 genotyping
E.
Permanently discontinue drug and explore next available therapy or clinical trial
F.
Uncertain

How often do you share resources with patients about available molecular testing, treatment options, AE management, copays, and other financial assistance programs?

A.
Never
B.
Rarely
C.
Sometimes
D.
Frequently
E.
Always

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Applying the Latest Developments in Metastatic Breast Cancer Through Education of Healthcare Professionals, Patients, and Caregivers

Joyce O'Shaughnessy, MD

Activity