Thread by @JohnEbbenMDPhD

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 2/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠:
#TNBC &neoadjuvant tx
✅KEYNOTE-522= new standard of care
– Pembro+chemo in neoadj= BEST pCR so far
– Caveat: only for T2+ TNBC
✅Adding pembro may have ⬆️benefit in RCB II
📚We captured much of chat:
p1: twitter.com/i/events/15423…

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 3/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠msgs (cont’d):
✅IO NOT shown to add benefit in metastatic dz
– Atezolizumab approval in mTNBC withdrawn
✅Standard of care – multi-d team
✅No current evidence to hold IO pre-op
P2: twitter.com/i/events/15425…

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 4/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠messages (cont’d):
✅THINK about side FX, including fertility
— Ovarian suppression may preserve fertility while undergoing neoadj tx
✅Patient voice is MOST important- pts define “acceptable tox,” not 🩺

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 5/11 #TumorBoardTuesday
Thursday Case🎀

@Dr_RShatsky presented a 36 yo 👩🏽‍🦱 w 3.5 cm breast mass & sus ax nodes. On bx ER, PR, HER2-

🤨What now?

Crowd thought about neoadj tx & role of germline genetics because of age, TNBC

‼️ We ALWAYS favor germline 🧬sequencing ‼️

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 6/11 #TumorBoardTuesday #LungCancer
Thurs Case🎀

Consensus settled on neoadj tx based on KEYNOTE-522.
What’s KEYNOTE-522?

4 cycles Carboplatin/Paclitaxel/Pembrolizumab ->
4 cycles AC/Pembro->
🔪surg

Controversy: ddAC or not? Most say ddAC, but no firm answer.

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen 7/11 #TumorBoardTuesday
Thursday Case🎀

Why KEYNOTE-522?
Phase III, randomized controlled trial
📍pCR rate was 64.8% vs. 51.2% in placebo arm.
📍EFS was 84.5% vs. 76.8% in placebo arm. A difference of 7.7%!

📚 @NEJM Feb, 2022 nejm.org/doi/full/10.10…

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen @NEJM 8/11 #TumorBoardTuesday
Thurs Case🎀

PD-L1 IS ❌NOT good marker for benefit from add of pembro to NAT.

Are TILs + PD-L1 better predictor? Studies ongoing @JaniceTNBCmets points out

Another conundrum: checkpoint inhibs seem to work in NAT setting, but not yet in metTNBC

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen @NEJM 9/11 #TumorBoardTuesday #LCSM
Thursday Case🎀

KEYNOTE-522 req careful coordination w surgery. Crowd had diff opinions when to give final pembro dose.

Recent meta-analyses show ❌NO effect of IO on wound healing, surgical outcomes. @pashtoonkasi

frontiersin.org/articles/10.33…

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen @NEJM @pashtoonkasi 10/11 #TumorBoardTuesday
Thursday Case🎀

Interestingly–greatest benefit (EFS) of adding pembro seen in pts w some residual disease (RCB II) at surg.

Controversy: IMPASSION-031- atezo✅ in NAT, but not in met dz. Should we use pembro or atezo? Open debate, physician specific

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen @NEJM @pashtoonkasi @JadeZhouMD @RebeccaDSing @Gladiolus25 11/11
Thurs Case🎀

🙏 Pt w pCR!!!
🤔 Many unanswered?...including role of adjuvant IO in #TNBC

➡️Please be sure to join us on 07.05.22 @ErikaHamilton9 & @Myshastry present a case of NAT in a BRCA-mut breast cancer!😀

Thank you for joining #TumorBoardTuesday!

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD @TNBCFoundation @DrLauraEsserman @abhenilmittal @JaniceTNBCmets @SusanGKomen @NEJM @pashtoonkasi @JadeZhouMD @RebeccaDSing @Gladiolus25 @Myshastry Remember #TumorBoardTuesday continues to offer AMA & MOC credit for FREE!
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