Thread by @prarthnavb

@TumorBoardTues 1/15 #TumorBoardTuesday #BCSM #BreastCancer #OncTwitter @drteplinsky

🎯45 yo premenopausal 👩‍🦰
❌relevant medical history.
FHx: Mom 👩‍🦳 with breast cancer at 48y
Screening mammogram normal for the last few years.
Now with microcalcifications 📏3mm in the UOQ of the R breast.

@TumorBoardTues @drteplinsky 2/15 #TumorBoardTuesday #BreastCancer #OncTwitter @MPishvaian @JohnEbbenMDPhD

👩‍🦰Underwent a biopsy
🔬Surgical pathology: Atypical ductal hyperplasia
✂️Underwent a lumpectomy confirming diagnosis and no additional findings

🤔Which of the following would you recommend for her?

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd 3/15 #TumorBoardTuesday #BreastCancer
👩🏻‍🏫Mini Tweetorial 1 👩🏽‍🏫

📍Indications for risk reduction using endocrine Rx recommended by @ASCO @NCCN

Age of ≥ 35y with life expectancy of 10y plus:
📌Thoracic RT <30y
📌High-risk breast lesions
📌≥1.7% 5y risk of breast cancer

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN 4/15 #TumorBoardTuesday
👩🏻‍🏫Mini Tweetorial 2👩🏽‍🏫

Risk reduct contd
⚡High-risk breast lesions
💥Atypical Ductal Hyperplasia (ADH)
💥Atypical Lobular Hyperplasia (ALH)
💥Lobular Carcinoma In-situ (LCIS)

⚡Ductal Carcinoma in-situ (DCIS)
👉@UpToDate for high-risk breast lesions & Rx

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky @enriquebargallo @DrKathAlsop

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky @enriquebargallo 5/15 #TumorBoardTuesday
👩🏻‍🏫Mini Tweetorial 3👩🏽‍🏫

Chemoprevention avail agents
☑️Tamoxifen
☑️Raloxifene
☑️Aromatase inhibitors (AI)

👍🏽Tamoxifen can be used for pre/postmenopausal women
👍🏽Raloxifene & AI used for postmenopausal women
📚Nelson @JAMA_current jamanetwork.com/journals/jama/…

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky @enriquebargallo @JAMA_current 6/15 #TumorBoardTuesday #BreastCancer
👩🏻‍🏫Mini tweetorial 4 👩🏽‍🏫

📌Side effects of full dose tamoxifen:

🥵Hot flashes
🛏️Effect on sexual health
😐mood change
🩸VTE
🧠Stroke
🚺Endometrial cancer
👀Cataracts

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky @enriquebargallo 7/15 #TumorBoardTuesday
Back to our patient🔎

👩‍🦰Starts on 20mg of tamoxifen per @NCCN guidelines but develops intense hot flashes 🥵affecting sleep.

👩‍🦰Wants to continue 💊 but worried about side effects.

🤔Would you recommend a lower dose of tamoxifen at 5mg (Baby-TAM) daily?

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky @enriquebargallo 8/15 #TumorBoardTuesday #BreastCancer #BCSM

✨TAM-01 study from 🇮🇹

📍N=500
🔉Study included patients with DCIS needing adjuvant endocrine Rx
👯: 20% ADH, 11% LCIS, 69% DCIS
📚 @AndreaDeCensi ascopubs.org/doi/10.1200/JC…

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @DrBBychkovsky 9/15 #TumorBoardTuesday
✨TAM-01

🗓️10y follow up published 03/2023 @JCO_ASCO

👍 42% ⬇️ in RR of #BreastCancer
👍 64% ⬇️ in contralateral BC HR 0.58 (.35, .95), p=.03
👍 NNT at 10y: 14
📚@AndreaDeCensi ascopubs.org/doi/10.1200/JC…

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD 10/15 #TumorBoardTuesday
✨TAM-01

📌Side effects

❌statistical difference from placebo
🩸DVT/PE: 0.4%
🫀CHD: 0.8%
🚺uterus Ca: 0.4%

❌ different
🥵Hot flashes score

📚Read more on side effects of baby-TAM @BrJCancer @DrWengstrom @signeborgquist nature.com/articles/s4141…

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer @DrWengstrom 11/15 #TumorBoardTuesday #BCSM @YAbdouMD
✨ TAM-01

👍🏽 50% ⬇️ in recurrence in DCIS cohort (70% of study pop).
👍🏽 Benefit seen in DCIS and not just atypical hyperplasia or LCIS

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer @DrWengstrom @YAbdouMD 12/15 #TumorBoardTuesday
✨TAM-01

👍🏽
✅Option for adjuvant Rx of DCIS
✅ ⏬ side effects
✅Risk reduction comparable to tamoxifen 20mg trials

⭕limitations
❎No comparison with 20mg of tamoxifen
❎NOT available as 5mg tabs - can take 10 every other day or cut in half daily

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer @DrWengstrom 13/15 #TumorBoardTuesday #BCSM #BreastCancer

💥Current guidelines for baby-TAM per @NCCN

If patient
✔️symptomatic on 20mg dose
✔️“unwilling or unable to take standard dose”
✔️Can take 5mg tamoxifen for 3 years

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer @DrWengstrom 14/15 #TumorBoardTuesday

‼️🕵🏽Baby-TAM needs to be studied in‼️
🩻 Increased #BreastCancer risk due to high breast density🤔
🧬 Genetic mutation carriers
☢️ Risk reduction in young women after chest RT

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer @DrWengstrom 15/15 #TumorBoardTuesday
Back to our case🔎

👩‍🦰 Decided to start baby-TAM 10mg every other day
🎉 Had improvement in hot flashes
👍 QoL
Completed 3 years of treatment! 👏

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @ehgkulow @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval integrityce.com/TBTeval23

🤔@drteplinsky @prarthnavb taught us use of baby-TAM, test your 🧠with quick Q’s

🧐What tx would you pick?
45 y/o premenopausal🚺
surgical resection
atypical ductal hyperplasia
mother 48y dx with #BreastCancer

@TumorBoardTues @drteplinsky @MPishvaian @JohnEbbenMDPhD @drRTee @masreya_dr @mabelonc @KadrinWilfong @TammyMarcotte11 @maur_jmp @eccarville @JAMouabbi @VaniaGodo @katsuki_arima @CPratilasMD @DrAmyComander @antoinedardenn1 @KoontzOncology @AMJohnston1315 @JaniceTNBCmets @Martha__Carlson @CCortiMD @khewittmd @csjeanmd @ASCO @NCCN @UpToDate @DrSGraff @chibaAkiko @gbc02 @LeandroJonatad1 @abotty02 @sarahvcolonna @amandaaminmd @mmejendouglas @Dr_RShatsky @ClayReedMD @awolff @jane_meisel @hoperugo @drsarahsam @PTarantinoMD @maryam_lustberg @adrianakahnmd @ramsedhom @OKantorMD @BrJCancer #PostTest Q2️⃣ #TumorBoardTuesday
👉🏽 Free CME 🔗 integrityce.com/TBT2023

🧐Your 45 y/o patient (above👆🏽) with atypical ductal hyperplasia initiates tamoxifen therapy & starts to have severe hot flashes.

🤔What daily dose of tamoxifen would you recommend for this patient?