eCase - Role of CDK4/6 Inhibitors in HR+/HER2- EBC

Introduction

In this module, Sara M. Tolaney, MD, MPH reviews the risk factors for breast cancer recurrence and current guidelines for the use of biomarkers in treatment decision-making and provides contextualized approaches for the individualization of adjuvant therapy for patients with hormone receptor (HR)-positive/HER2-negative high-risk early breast cancer (EBC).

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, including slide notes, which can be found here.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

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

How many people with breast cancer do you provide care for in a typical month?

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

Which of the following is associated with high risk of recurrence and would help to inform optimal adjuvant therapy for newly diagnosed patients with HR-positive/HER2-negative EBC?

A.
High estrogen receptor (ER) and/or high progesterone receptor (PR) levels, postmenopausal status
B.
High BMI and PI3KCA or ESR1 gene status
C.
Premenopausal, luminal A, grade 2
D.
Tumor size ≥5 cm, high Ki-67, and axillary lymph node (ALN)–positive status

A 57-year-old postmenopausal woman presents with a palpable mass in her right breast. Mammogram/ultrasound showed a >5 cm mass with enlarged, suspicious ALN. Core biopsy reveals grade 1 invasive lobular carcinoma, ER-positive/PR-positive/HER2-negative disease, and lymph node biopsy showed node-positive carcinoma. CT staging and germline testing are negative. The patient has preexisting QT prolongation.

Right breast mastectomy and ALN dissection were performed and reveal 5.2 cm mass, grade 1 invasive lobular carcinoma with 2/3 positive lymph nodes. She received adjuvant chemotherapy with dose-dense doxorubicin plus cyclophosphamide followed by 12 weeks of paclitaxel. She undergoes radiotherapy to the right chest wall and regional nodes.

Based on the patient’s tumor characteristics, predictive biomarkers and existing comorbidities, which of the following would you recommend as the most appropriate systemic adjuvant therapy for this patient?

A.
Aromatase inhibitor (AI) alone
B.
AI plus abemaciclib
C.
Tamoxifen plus ribociclib
D.
AI plus olaparib

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Risk Factors for Recurrence, Molecular Testing, and Treatment of Patients With HR-Positive/HER2-Negative EBC

Sara M. Tolaney, MD, MPH

Activity

Introduction

How many people with breast cancer do you provide care for in a typical month?

Which of the following is associated with high risk of recurrence and would help to inform optimal adjuvant therapy for newly diagnosed patients with HR-positive/HER2-negative EBC?

Based on the patient’s tumor characteristics, predictive biomarkers and existing comorbidities, which of the following would you recommend as the most appropriate systemic adjuvant therapy for this patient?