Thread by @ErikaHamilton9

@TumorBoardTues @MPishvaian @HeekeMd 1/14

#TumorBoardTuesday #bcsm

Join us to discuss a personalized approach to BC tx in pts with ER+ #bcsm

A 53 yo👩 with HR+, HER2- IDC, very large grade 3 tumor, multiple + nodes

@OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam 2/14

#TumorBoardTuesday #bcsm

She has 3👨‍👦‍👦,🚭, no comorbidities

FMHx: maternal aunt had gastric cancer & paternal cousin had CRC

Tx with neoadjuvant AC ----> T with some response but significant residual disease. 😥

What info would you need to treat this patient?

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam 3/14 #TumorBoardTuesday #bcsm Mini-Tweetorial 1

Only 12% of ♀️ in general population develop BC, BUT 55-65% of ♀️ with inherited BRCA1 can develop BC!

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD 4/14 #TumorBoardTuesday #bcsm Mini-tweetorial 2

MOA of Olaparib, a PARP inhibitor

[M. Akay et al. Oncology and therapy 9,347-364 (2021)]

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD 5/14

#TumorBoardTuesday #bcsm Mini-tweetorial 3

What is CPS+EG score ❓❓❓

Clin-path scoring sys + ER & Grade (CPS+EG) incl tumor biol w staging to assess prognosis post NAC. Points per factor added to get CPS+EG score. Scores from 0 - 6, with up⬆️ scores = 👎 prognosis.

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD 6/14 #TumorBoardTuesday #bcsm Mini-tweetorial 4
CPS+EG Point assignment

(Mittendorf EA et al 2011)

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD 7/14

#TumorBoardTuesday #bcsm Mini-tweetorial 5
Want to know how to 📲CPS+EG score for your pt?

Here’s the link:
www3.mdanderson.org/app/medcalc/in…

(yes, I actually use the internet 🖥️link)

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD 8/14

#TumorBoardTuesday #BRCA Mini-tweetorial 6
#OlympiA @myESMO

How do we know that Olaparib improves outcomes in gBRCA mutant BC? The OlympiA trial....

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 9/14

#TumorBoardTuesday #OlympiA Mini-tweetorial 7

💊Adjuvant olaparib vs placebo – results from #OlympiA:

✅ ⬆️8.8% in 3 yr iDFS
✅ ⬆️7.1% in 3 yr dDFS
✅ ⬆️3.4% in 4 yr OS rate

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 10/14 #TumorBoardTuesday @MarkRobsonMD

Who should undergo genetic testing for BRCA1/2? Very critical to test patients now that we have an approved therapeutic.

Current NCCN guidelines for BRCA 1/2 testing 👇

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 11/14 #TumorBoardTuesday #bcsm #onctwitter #BRCA

Adjuvant #olaparib therapy not appropriate for:

oLow risk pts and/or do not meet OlympiA criteria (ie, node negative ER+, etc.)
oPts with high stage tumors who achieve pCR with NAC

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 12/14 #TumorBoardTuesday Back to our case🔎

Our patient 👩received olaparib 💊, was dose reduced after 4 months due to fatigue 😩.

She completed 1 year 📆and is now remains on endocrine therapy and is doing well 🍾🎉.

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 13/14 #TumorBoardTuesday

Back to our case🔎

Olaparib - only approved PARPi for adjuvant tx of pts w/ gBRCA high risk, HER2- EBC after neoadjuvant or adjuvant chemo

accessdata.fda.gov/drugsatfda_doc…

fda.gov/drugs/resource…

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD 14/14

#TumorBoardTuesday #PARP #bcsm

Common AEs with olaparib on #OlympiA:

⬆️Nausea 🤢
⬆️Fatigue 😴
⬆️Anemia 🩸
AEs of special interest:
MDS/AML ~3.4%

@TumorBoardTues @MPishvaian @HeekeMd @OncoAlert @BurrisSkip @KalinskyKevin @matteolambe @Dr_RShatsky @maryam_lustberg @drsarahsam @hoperugo @Myshastry @YAbdouMD @EMittendorfMD @myESMO @MarkRobsonMD Thank you ALL- @JaniceTNBCmets @JohnEbbenMDPhD @Dr_RShatsky @OncBrothers @Myshastry @MPishvaian etc. for the past hour ⏰ of conversation!

Amazing how fast the time can fly by!

#TumorBoardTuesday