@TumorBoardTues 1/15 #TumorBoardTuesday #BreastCancer #OncTwitter
59yo 👩🏽
palpable left breast mass
Dx: clinical prognostic stage IIB node positive (cT2N1) ER+/PR-/HER2+ poorly differentiated invasive ductal carcinoma.
She’s referred for neoadjuvant chemotx.
🤨What treatment do you offer her?
59yo 👩🏽
palpable left breast mass
Dx: clinical prognostic stage IIB node positive (cT2N1) ER+/PR-/HER2+ poorly differentiated invasive ductal carcinoma.
She’s referred for neoadjuvant chemotx.
🤨What treatment do you offer her?
@TumorBoardTues 2/15 #TumorBoardTuesday #BCSM
👩🏽 receives neoadjuvant chemotherapy with TCHP.
👩🏽 undergoes left mastectomy & sentinel lymph node biopsy & is found to have 12 mm of residual disease in breast.
No residual disease in the lymph nodes.
🤨 What adjuvant treatment do you recommend?
👩🏽 receives neoadjuvant chemotherapy with TCHP.
👩🏽 undergoes left mastectomy & sentinel lymph node biopsy & is found to have 12 mm of residual disease in breast.
No residual disease in the lymph nodes.
🤨 What adjuvant treatment do you recommend?
@TumorBoardTues 3/15 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 1
✨KATHERINE Trial✨
🔸randomized open-label
🔸1486 🚺 with residual invasive HER2-positive early #BreastCancer after neoadjuvant taxane-containing chemotx +/- anthracyclines & trastuzumab
📚von Minckwitz @NEJM pubmed.ncbi.nlm.nih.gov/30516102
👩🏻🏫Mini tweetorial 1
✨KATHERINE Trial✨
🔸randomized open-label
🔸1486 🚺 with residual invasive HER2-positive early #BreastCancer after neoadjuvant taxane-containing chemotx +/- anthracyclines & trastuzumab
📚von Minckwitz @NEJM pubmed.ncbi.nlm.nih.gov/30516102
@TumorBoardTues @NEJM 4/15 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 2
✨KATHERINE✨
🔸Women received adjuvant treatment with 14 cycles of T-DM1 vs trastuzumab
📍Treatment with T-DM1 improved 3y invasive disease 🆓survival (88.3% vs 77% with trastuzumab, HR 0.5; 95% CI, 0.39-0.64, P<0.001)
see👇🏽👇🏽below
👩🏻🏫Mini tweetorial 2
✨KATHERINE✨
🔸Women received adjuvant treatment with 14 cycles of T-DM1 vs trastuzumab
📍Treatment with T-DM1 improved 3y invasive disease 🆓survival (88.3% vs 77% with trastuzumab, HR 0.5; 95% CI, 0.39-0.64, P<0.001)
see👇🏽👇🏽below
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff 5/15 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 3
✨KATHERINE✨
🔸showed⬇️risk of distant recurrence in T-DM1 vs tras➡️10.5% vs 15.9%➡️HR 0.6; 95% CI, 0.45-0.79
🔸98 deaths➡️42 in T-DM1 grp vs 56 in trastuzumab
🔸OS didn’t cross early reporting boundary➡️HR 0.7, 95% CI, 0.47 to 1.05
👩🏻🏫Mini tweetorial 3
✨KATHERINE✨
🔸showed⬇️risk of distant recurrence in T-DM1 vs tras➡️10.5% vs 15.9%➡️HR 0.6; 95% CI, 0.45-0.79
🔸98 deaths➡️42 in T-DM1 grp vs 56 in trastuzumab
🔸OS didn’t cross early reporting boundary➡️HR 0.7, 95% CI, 0.47 to 1.05
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff 6/15 #TumorBoardTuesday #BCSM
👩🏻🏫Mini tweetorial 4
✨KATHERINE✨
📍T-DM1 benefit in all subgroups
📍Analysis showed T-DM1 benefit in pts with <1cm of residual dz in breast & (-) lymph nodes.
📍Benefit of T-DM1 regardless of which neoadjuvant HER2-targeted therapy was given.
👩🏻🏫Mini tweetorial 4
✨KATHERINE✨
📍T-DM1 benefit in all subgroups
📍Analysis showed T-DM1 benefit in pts with <1cm of residual dz in breast & (-) lymph nodes.
📍Benefit of T-DM1 regardless of which neoadjuvant HER2-targeted therapy was given.
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff 7/15 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 5
✨KATHERINE✨
🔸only ≈18% of pts received BOTH trastuzumab & pertuzumab
📍benefit of T-DM1 in adjuvant setting persisted
🔸Invasive disease-free events occurred in 12 pts in T-DM1 & 24 pts in trastuzumab (HR 0.5, 95% CI 0.25 to 1.00)
👩🏻🏫Mini tweetorial 5
✨KATHERINE✨
🔸only ≈18% of pts received BOTH trastuzumab & pertuzumab
📍benefit of T-DM1 in adjuvant setting persisted
🔸Invasive disease-free events occurred in 12 pts in T-DM1 & 24 pts in trastuzumab (HR 0.5, 95% CI 0.25 to 1.00)
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff 8/16 #TumorBoardTuesday
👩🏻🏫Mini tweetorial 6
✨KATHERINE✨
T-DM1 AEs
most common
😴fatigue
🤢nausea
🩸decreased platelet count
⬆️AST/ALT
🤕headache
🦴arthralgias
☢️radiation-related skin injury
👃epistaxis
🦵peripheral sensory neuropathy
🚽constipation
💪🏽myalgias
🥵hot flashes
👩🏻🏫Mini tweetorial 6
✨KATHERINE✨
T-DM1 AEs
most common
😴fatigue
🤢nausea
🩸decreased platelet count
⬆️AST/ALT
🤕headache
🦴arthralgias
☢️radiation-related skin injury
👃epistaxis
🦵peripheral sensory neuropathy
🚽constipation
💪🏽myalgias
🥵hot flashes
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 9/15 #TumorBoardTuesday #BCSM
👩🏻🏫Mini tweetorial 7
✨KATHERINE✨
T-DM1 AEs
📌Majority of the above AE’s were G1 or G2
Baseline peripheral neuropathy (PN) is associated with longer PN duration & lower resolution rate.
🧐What has been your experience with T-DM1 side effects?
👩🏻🏫Mini tweetorial 7
✨KATHERINE✨
T-DM1 AEs
📌Majority of the above AE’s were G1 or G2
Baseline peripheral neuropathy (PN) is associated with longer PN duration & lower resolution rate.
🧐What has been your experience with T-DM1 side effects?
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 10/15 #TumorBoardTuesday #BCSM
👩🏻🏫Mini tweetorial 8
✨KATHERINE✨
🕵️Subgroup analysis published in 2021
📌Central nervous system (CNS) more often site of 1st recurrence in T-DM1 arm (5.9% vs 4.3%)
🔷BUT ➡️ T-DM1 not associated with a difference in overall risk of CNS recurrence
👩🏻🏫Mini tweetorial 8
✨KATHERINE✨
🕵️Subgroup analysis published in 2021
📌Central nervous system (CNS) more often site of 1st recurrence in T-DM1 arm (5.9% vs 4.3%)
🔷BUT ➡️ T-DM1 not associated with a difference in overall risk of CNS recurrence
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 11/15 #TumorBoardTuesday
KATHERINE
63 pts dc T-DM1 d/t tox but complete 14 trastuzumab cycles
18% in T-DM1 Grp had AE ➡️drug d/c. 71/133 switched to tras
d/c reasoning
⬇️platelets
⬆️LFTs (bilirubin, AST, ALT)
🦵peripheral neuropathy
⬇️eject fraction
What do YOU switch when dc?
KATHERINE
63 pts dc T-DM1 d/t tox but complete 14 trastuzumab cycles
18% in T-DM1 Grp had AE ➡️drug d/c. 71/133 switched to tras
d/c reasoning
⬇️platelets
⬆️LFTs (bilirubin, AST, ALT)
🦵peripheral neuropathy
⬇️eject fraction
What do YOU switch when dc?
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 12/15 #TumorBoardTuesday
DESTINY-Breast05
T-DM1 vs T-DXd
🔹pts with invasive residual breast or axillary lymph node dz & ⬆️risk of recur
🔸High risk=inoperable prior to neoadju (T4,N0-3,M0 OR T1-3,N2-3,M0) OR operable at start (T1-3,N0-1,M0) with residual axilla dz after neoadj
DESTINY-Breast05
T-DM1 vs T-DXd
🔹pts with invasive residual breast or axillary lymph node dz & ⬆️risk of recur
🔸High risk=inoperable prior to neoadju (T4,N0-3,M0 OR T1-3,N2-3,M0) OR operable at start (T1-3,N0-1,M0) with residual axilla dz after neoadj
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 13/15 #TumorBoardTuesday #BCSM #BreastCancer
⚡️Important ongoing clinical trials for T-DM1 to T-DXd for high risk patients with residual disease ⚡️
✨DESTINY-Breast05 (previous tweet): clinicaltrials.gov/ct2/show/NCT04…
✨DESTINY-Breast11: clinicaltrials.gov/ct2/show/NCT05…
⚡️Important ongoing clinical trials for T-DM1 to T-DXd for high risk patients with residual disease ⚡️
✨DESTINY-Breast05 (previous tweet): clinicaltrials.gov/ct2/show/NCT04…
✨DESTINY-Breast11: clinicaltrials.gov/ct2/show/NCT05…
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 14/15 #TumorBoardTuesday
Completed clinical trial for residual #BreastCancer⬇️
📍T-DM1 (KATHERINE) for residual breast or axilla dz after neoadjuvant based anti HER2 tx.
📍More AEs with T-DM1 vs trastuzumab mono, use of T-DM1👍🏽invasive dz🆓survival vs trastuzumab.
Completed clinical trial for residual #BreastCancer⬇️
📍T-DM1 (KATHERINE) for residual breast or axilla dz after neoadjuvant based anti HER2 tx.
📍More AEs with T-DM1 vs trastuzumab mono, use of T-DM1👍🏽invasive dz🆓survival vs trastuzumab.
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala 15/15 #TumorBoardTuesday
Back to our case🔎
👩🏽started on T-DM1 for 14 cycles
🚩Grade 3 AST/ALT elevation
✅requires dose reduction from 3.6 mg/kg to 3 mg/kg
✅able to complete full planned course
🧐What has been your experience with T-DM1 dose reductions?
Back to our case🔎
👩🏽started on T-DM1 for 14 cycles
🚩Grade 3 AST/ALT elevation
✅requires dose reduction from 3.6 mg/kg to 3 mg/kg
✅able to complete full planned course
🧐What has been your experience with T-DM1 dose reductions?
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval🔗 integrityce.com/tbtEval
🤔@drteplinsky taught us early stage HER2+, test your 🧠 with 2 quick❓
🧐What adjuvant tx would U pick for pt with localized,HR-, HER2+ BC with pathologic complete response (R0 resection) post neoadj TCHP?
👉🏽#CME Eval🔗 integrityce.com/tbtEval
🤔@drteplinsky taught us early stage HER2+, test your 🧠 with 2 quick❓
🧐What adjuvant tx would U pick for pt with localized,HR-, HER2+ BC with pathologic complete response (R0 resection) post neoadj TCHP?
@TumorBoardTues @NEJM @gary_lyman @DrTJM_MD @g_mountzios @IdoWolf5 @NicoleKuderer @FlaviaJacobs_ @CarmenCriscit @mauricallari @Dr_RShatsky @DrSGraff @dradesnoyers @SoniaPernas @OlofssonBagge @AlisonSvoboda @Icro_Meattini @Mattia_Rediti @kevinpunie @stephaniemwong @naborala #PostTest Q2️⃣ #TumorBoardTuesday
👉🏽Free #CME🔗: integrityce.com/tbt
🧐What adjuvant treatment approach (FDA-approved or clinical trial) would you pick for a patient with early-stage #BreastCancer & residual disease AFTER completion of HER2-🎯 neoadjuvant therapy?
👉🏽Free #CME🔗: integrityce.com/tbt
🧐What adjuvant treatment approach (FDA-approved or clinical trial) would you pick for a patient with early-stage #BreastCancer & residual disease AFTER completion of HER2-🎯 neoadjuvant therapy?
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