Med Onc Flashcards
Which chemotherapy to give HR+/HER2- in the (neo)adjuvant setting?
Lee:
MammaPrint (FLEX registry trial):
High (H2 vs H1): (neo)adjuvant chemo benefit. ET 0-5 years.
H2 - Increased sensitivity to PARPi, IO, platinum agents. Increased sensitivity to anthracyclines (higher pCR). Behaves more like TNBC, has immune activated state.
H1 - No increased sensitivity to PARPi, IO, platinum agents
Low: No chemo benefit. ET 0-5 years. Extended ET benefit 6-10 years.
Ultra-Low: No chemo benefit. ET 2-5 years.
Takeaway:
MP H2, Blueprint Luminal B had lower risk of recurrence at 3 years if they receive AC/T rather than TC. (97.7% RFS versus 86.4%)
Luminal MP H1 have similar risk of recurrence with TC and AC/T (no added benefit for anthra)
Carboplatin in early stage TNBC?
PEARLY RCT (Sohn) - presented at ASCO 2024:
Addition of carboplatin to standard anthra/taxane therapy significantly improved EFS.
Safely profile expected, no diff in QoL.
Underscores value in KN522 NACT regimen. Suggests potential applicability for adjuvant.
Which taxane for black women, early stage BCA?
ECOG-ACRIN EAZ171: Prospective validation trial of germline variants and taxane type in association with taxane induced peripheral neuropathy, black women, early stage
Black women have worse outcomes (survival, toxicity)
Higher rates of TIPN (taxane induced peripheral neuropathy)
Weekly paclitaxel (x12) higher rates TIPN compared with docetaxel q3w (x4-6)
White: 22.4% vs 17.8%.
Black: 27.7% vs 13.2%
Trial did not meet primary endpoint (not validated) but trend noted. Black pts may therefore do better with docetaxel q3 weeks compared with weekly paclitaxel
How to personalize info from ODx for node positive patients?
RSClinN+ tool: Integrates RS score with clin-path variables for ER+/HER2- N1 (1-3 nodes)
Outperformed RS score or clin-path alone
Is this prime time?
What is the most efficacious first line chemo for HR+/HER2- MBC?
DESTINY-06: Trastuzumab deruxtecan (TDx) for HER2 low or ultra-low metastatic BCA with prior ET
Improved PFS compared with standard chemo (TPC-treatment of physician choice) for HER2 low
(Results felt to be consistent in the HER2 ultra-low population as well)
Consider use as first line therapy for higher risk HR+/HER2- MBC
