Systemic Therapy

Question 1

40 yo with Her2+ early stage breast cancer treated with neoadjuvant chemo and trastuzumab and found to have residual invasive disease in her axilla at surgery, what is the recommended adjuvant systemic therapy?

Answer 1

Trastuzumab emtansine (T-DM1)

Question 2

Trastuzumab emtansine (T-DM1) is recommended for residual invasive dz in axilla based on what study?

Answer 2

Phase III trial, KATHERINE trial showed pts with early stage Her2+ with residual invasive disease following neoadjuvant taxane-containing chemo (+/- anthracyclines) and trastuzumab were randomized into one of the following arms:

Adj tx with 14 cycles of T-DM1 vs Trastuzumab

Pts with T-DM1 showed improved disease free survival 88% vs. 77% and decreased distant recurrence 10.5% vs. 16%

Question 3

What score is used to decide to give chemo?

Answer 3

Oncotype DX score

If < 18, then no chemotherapy

score 18-30, unclear

> 30, then yes chemo

Question 4

What is the choice of chemo for Her2- invasive breast cancer?

Answer 4

AC (Adriamycin, cyclophosphamide) 4 cycles

or

ddAC (dose dense AC, administered twice for every 4 week cycle) x 4 cycles

or

FAC (fluorouracil, Adriamycin, and cyclophosphamide) 4 cycles

Then followed by q1wk x12 cycles of paclitaxel

Question 5

What is the typical Her2 based chemotherapy for Her2+?

Answer 5

THP (paclitaxel, Herceptin, pertuzumab) x6, then consider ddAC q2wk x4 cycles pre or postop –> maintenance Herceptin q3wk (total 1 year)

Question 6

What is alternate Her2+ regimen?

Answer 6

TCHP (paclitaxel, carboplatin, Hereptin, pertuzumab) x 6 cycles –> maintenance Herceptin q3wk (total 1 year)

Question 7

How long do breast cancer patients need to be on hormone therapy (tamoxifen or aromatase inhibitor)?

Answer 7

5-10 years