@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca 1/18 #TumorBoardTuesday #BCSM #OncTwitter
59yo 👩 presents with left rib cage pain & fatigue
PMH: HTN
FH: Aunt with #BreastCancer
🕓2014: Right T2N0 IDC G2
ER 95% PR 40% HER2 0
Oncotype 32
Germline 🧬 testing neg
S/p right lumpectomy + SLNB ➡️ TC x 4 ➡️ XRT ➡️ letrozole x 5 yrs
59yo 👩 presents with left rib cage pain & fatigue
PMH: HTN
FH: Aunt with #BreastCancer
🕓2014: Right T2N0 IDC G2
ER 95% PR 40% HER2 0
Oncotype 32
Germline 🧬 testing neg
S/p right lumpectomy + SLNB ➡️ TC x 4 ➡️ XRT ➡️ letrozole x 5 yrs
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca 2/18 #TumorBoardTuesday @PTarantinoMD
🩻CT CAP + bone scan: Spine/ribs/pelvis mets
🔬Left rib bx: IDC, G2, ER 90% PR 0% HER2 1+
🧬NGS: ESR1 neg
🩸Labs: WNL
Receives 1L exemestane + ribo + zoledronate (PFS 1.5 yrs) ➡️ 2L everolimus + fulvestrant (PFS 3 mos) ➡️ 3L capecitabine
🩻CT CAP + bone scan: Spine/ribs/pelvis mets
🔬Left rib bx: IDC, G2, ER 90% PR 0% HER2 1+
🧬NGS: ESR1 neg
🩸Labs: WNL
Receives 1L exemestane + ribo + zoledronate (PFS 1.5 yrs) ➡️ 2L everolimus + fulvestrant (PFS 3 mos) ➡️ 3L capecitabine
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_Meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD 3/18 #TumorBoardTuesday @MPishvaian @JohnEbbenMDPhD @z_veitch @PiotrOkupski @NicoleKuderer
🕓6 mos after initiating capecitabine
👩presents with progressive fatigue + pain
🩻CT CAP: Progression in bones + new multifocal liver lesions
🤨What systemic tx would you recommend?
🕓6 mos after initiating capecitabine
👩presents with progressive fatigue + pain
🩻CT CAP: Progression in bones + new multifocal liver lesions
🤨What systemic tx would you recommend?
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @z_veitch @PiotrOkupski @NicoleKuderer 4/18 #TumorBoardTuesday @AlanaWelm @amybeumer
👩🏼🏫Mini tweetorial 1👨🏻🏫
📌HER2-low #BreastCancer
🔹~50% BCs have HER2-low expression (traditionally classified as HER2-neg)
🔹HER2-low definition: HER2 IHC score 1+ or 2+ with negative ISH assay
📚@PTarantinoMD ascopubs.org
👩🏼🏫Mini tweetorial 1👨🏻🏫
📌HER2-low #BreastCancer
🔹~50% BCs have HER2-low expression (traditionally classified as HER2-neg)
🔹HER2-low definition: HER2 IHC score 1+ or 2+ with negative ISH assay
📚@PTarantinoMD ascopubs.org
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @AWolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @Dr_RShatsky @ESchattner @faceofstage4 @HeatherMoore16 @JessSFisher @ourmbclife @sarahvcolonna @EricabennettRTT @Timharvey32Lisa
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @Dr_RShatsky @ESchattner @faceofstage4 @HeatherMoore16 @JessSFisher @ourmbclife @sarahvcolonna @EricabennettRTT 5a/18 #TumorBoardTuesday @CarmenCalfa #BreastCancer
👩🏼🏫Mini tweetorial 2👨🏻🏫
📌HER2-low subtype
📖Studies show ONLY marginal differences in HER2-low vs HER2-0 tumor:
🔬clinicopathologic features
🧬genomics*
📍prognosis*
*after controlling for HR expression (⬆️ in HER2-low)
👩🏼🏫Mini tweetorial 2👨🏻🏫
📌HER2-low subtype
📖Studies show ONLY marginal differences in HER2-low vs HER2-0 tumor:
🔬clinicopathologic features
🧬genomics*
📍prognosis*
*after controlling for HR expression (⬆️ in HER2-low)
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 5b/18 #TumorBoardTuesday #BCSM @emperorblackmd @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp #BreastCancer
📌HER2-low subtype resources
📚@FrancescoSche20 nature.com
📚@theproffermd jamanetwork.com
📚@PTarantinoMD jamanetwork.com
📌HER2-low subtype resources
📚@FrancescoSche20 nature.com
📚@theproffermd jamanetwork.com
📚@PTarantinoMD jamanetwork.com
nature.com/articles/s4152…
Clinical, pathological, and PAM50 gene expression features of HER2-low breast cancer
npj Breast Cancer - Clinical, pathological, and PAM50 gene expression features of HER2-low breast ca...
jamanetwork.com/journals/jamao…
Prognostic and Biologic Significance of ERBB2-Low Expression in Early-Stage Breast Cancer
This cohort study investigates the association of ERBB-2 expression with clinicopathologic character...
jamanetwork.com/journals/jamao…
Clinicopathologic Characteristics and Prognosis of ERBB2-Low Breast Cancer in the National Cancer Database
This cohort study uses National Cancer Database data to investigate whether breast cancer with low E...
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 6a/18 #TumorBoardTuesday
👩🏼🏫Mini tweetorial 3👨🏻🏫
📌HER2-low expression is dynamic
HER2-low status can change from:
🔬baseline bx ➡️ residual dz s/p preop tx
🧭primary ➡️ recurrent tumor
even within 1️⃣ pt at same timepoint based on tissue location
📚@FedeMiglietta @GeukensTatjana
👩🏼🏫Mini tweetorial 3👨🏻🏫
📌HER2-low expression is dynamic
HER2-low status can change from:
🔬baseline bx ➡️ residual dz s/p preop tx
🧭primary ➡️ recurrent tumor
even within 1️⃣ pt at same timepoint based on tissue location
📚@FedeMiglietta @GeukensTatjana
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @FedeMiglietta 6b/18 #TumorBoardTuesday #BCSM
📌Evolution of HER2-low #BreastCancer
📚ejcancer.com
📚nature.com
📚aacrjournals.org
👨💻@prat_aleix #ESMO21
📌Evolution of HER2-low #BreastCancer
📚ejcancer.com
📚nature.com
📚aacrjournals.org
👨💻@prat_aleix #ESMO21
nature.com/articles/s4152…
Evolution of HER2-low expression from primary to recurrent breast cancer
npj Breast Cancer - Evolution of HER2-low expression from primary to recurrent breast cancer
aacrjournals.org/cancerres/arti…
Abstract HER2-16: HER2-16 Inter-lesion heterogeneity of HER2-status in metastatic breast cancer: possible implications for treatment with anti-HER2 antibody-drug conjugates
Abstract. Background. Trastuzumab deruxtecan (T-DXd) has shown promising activity in patients with H...
ejcancer.com/article/S0959-…
Evolution of low HER2 expression between early and advanced-stage breast cancer
Low human epidermal growth factor receptor 2 (HER2) expression is emerging as an actionable biomarke...
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @FedeMiglietta @prat_aleix 7/18 #TumorBoardTuesday
👩🏼🏫Mini tweetorial 4👨🏻🏫
✍🏼Guidance by ESMO Consensus on HER2-low mBC
➡️ HER2-low biopsy result at ANY timepoint (including primary tumor) can render a pt T-DXd eligible
🔬Consider repeat biopsy in pts with only HER2-0 prior Bx
📚annalsofoncology.org
👩🏼🏫Mini tweetorial 4👨🏻🏫
✍🏼Guidance by ESMO Consensus on HER2-low mBC
➡️ HER2-low biopsy result at ANY timepoint (including primary tumor) can render a pt T-DXd eligible
🔬Consider repeat biopsy in pts with only HER2-0 prior Bx
📚annalsofoncology.org
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @FedeMiglietta @prat_aleix 8/18 #TumorBoardTuesday
👩🏼🏫Mini tweetorial 5👨🏻🏫
📌Trastuzumab deruxtecan (T-DXd)
✨DESTINY-Breast 04: phase 3 trial
🙌🏽improved PFS & OS vs physician’s choice chemo for pretreated pts with HER2-low mBC in overall population, HR+, & TNBC cohorts
📚#ShanuModi nejm.org
👩🏼🏫Mini tweetorial 5👨🏻🏫
📌Trastuzumab deruxtecan (T-DXd)
✨DESTINY-Breast 04: phase 3 trial
🙌🏽improved PFS & OS vs physician’s choice chemo for pretreated pts with HER2-low mBC in overall population, HR+, & TNBC cohorts
📚#ShanuModi nejm.org
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @FedeMiglietta @prat_aleix 9/18 #TumorBoardTuesday #BCSM #BreastCancer
👩🏼🏫Mini tweetorial 6👨🏻🏫
📌HER2-low mBC T-DXd candidates
🔹HR+: After progression on ≥1 endocrine tx (70% of DB04 pts had prior CDK4/6i)
🔹All: After ≥1 line of chemo (or recurrence within 6 mos of [neo]adjuvant chemo)
👩🏼🏫Mini tweetorial 6👨🏻🏫
📌HER2-low mBC T-DXd candidates
🔹HR+: After progression on ≥1 endocrine tx (70% of DB04 pts had prior CDK4/6i)
🔹All: After ≥1 line of chemo (or recurrence within 6 mos of [neo]adjuvant chemo)
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 10a/18 #TumorBoardTuesday #ASCO23 #BCSM
👩🏼🏫Mini tweetorial 7👨🏻🏫
📌Sequencing T-DXd & saci in HER2-low mBC
📊Few guidance data
📈OS benefit for both!
✨DB04
✨ASCENT @dradityabardia
✨TROPICS-02 @stolaney1
💭HR+ pts: Consider prioritizing T-DXd given study pop was less pretreated
👩🏼🏫Mini tweetorial 7👨🏻🏫
📌Sequencing T-DXd & saci in HER2-low mBC
📊Few guidance data
📈OS benefit for both!
✨DB04
✨ASCENT @dradityabardia
✨TROPICS-02 @stolaney1
💭HR+ pts: Consider prioritizing T-DXd given study pop was less pretreated
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia 10b/18 #TumorBoardTuesday #BCSM #BreastCancer
📌Sequencing T-DXd & saci in HER2-low mBC resources
📚@RachelAbelman ascopubs.org
✨ASCENT
📚nejm.org
✨TROPICS-02
📚thelancet.com
📌Sequencing T-DXd & saci in HER2-low mBC resources
📚@RachelAbelman ascopubs.org
✨ASCENT
📚nejm.org
✨TROPICS-02
📚thelancet.com
thelancet.com/journals/lance…
Overall survival with sacituzumab govitecan in hormone receptor-positive and human epidermal growth factor receptor 2-negative metastatic breast cancer (TROPiCS-02): a randomised, open-label, multicentre, phase 3 trial
Sacituzumab govitecan demonstrated statistically significant and clinically meaningful benefit over...
nejm.org/doi/full/10.10…
Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer | NEJM
Original Article from The New England Journal of Medicine — Sacituzumab Govitecan in Metastatic Trip...
ascopubs.org/doi/abs/10.120…
Sequential use of antibody-drug conjugate after antibody-drug conjugate for patients with metastatic breast cancer: ADC after ADC (A3) study.
1022 Background: Optimizing sequential use of Antibody Drug Conjugates (ADCs) is an area of unmet ne...
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia @RachelAbelman 11/18 #TumorBoardTuesday #BCSM
Back to our case🔎
👩initiates T-DXd 5.4 mg/kg q3wk
💊First 2 cycles well tolerated apart from G1 nausea, alopecia, & G1 neutropenia
🫀Baseline echo: Normal, EF 60%
🩻CT CAP after 6 wks: Partial response of liver lesions, ⬆️ sclerosis of bone mets
Back to our case🔎
👩initiates T-DXd 5.4 mg/kg q3wk
💊First 2 cycles well tolerated apart from G1 nausea, alopecia, & G1 neutropenia
🫀Baseline echo: Normal, EF 60%
🩻CT CAP after 6 wks: Partial response of liver lesions, ⬆️ sclerosis of bone mets
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia @RachelAbelman 12/18 #TumorBoardTuesday #BCSM #BreastCancer #ASCO22
✨DESTINY-Breast 04
📌Most common T-DXd AEs
🔹any grade
🤢Nausea - highly emetogenic, use 3-drug prophylactic antiemetic regimen (5-HT3 + dex + NK1)
🥱Fatigue
🧑🏼🦲Alopecia
🔹grade 3+
🩸Neutropenia
🩸Anemia
🥱Fatigue
✨DESTINY-Breast 04
📌Most common T-DXd AEs
🔹any grade
🤢Nausea - highly emetogenic, use 3-drug prophylactic antiemetic regimen (5-HT3 + dex + NK1)
🥱Fatigue
🧑🏼🦲Alopecia
🔹grade 3+
🩸Neutropenia
🩸Anemia
🥱Fatigue
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia 13/18 #TumorBoardTuesday
⚠️Serious T-DXd AEs⚠️
🫁Interstitial lung disease - Watch via CT q6-12wks
🫀Cardiomyopathy - Watch via baseline echo/MUGA then q3-6mos
🚫Avoid T-DXd:
🦠PMH major CVD
🫁non-infect ILD needing steroids
🫁ongoing ILD
📚@IlanaSchlam thebreastonline.com
⚠️Serious T-DXd AEs⚠️
🫁Interstitial lung disease - Watch via CT q6-12wks
🫀Cardiomyopathy - Watch via baseline echo/MUGA then q3-6mos
🚫Avoid T-DXd:
🦠PMH major CVD
🫁non-infect ILD needing steroids
🫁ongoing ILD
📚@IlanaSchlam thebreastonline.com
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia @IlanaSchlam 14/18 #TumorBoardTuesday #BCSM #BreastCancer
Back to our case🔎
🩻 CT CAP after 12 wks:
Partial response in liver, stable bone mets, new consolidation and GGO in B/L lower lobes
👩 Patient denies SOB, cough, or fever
🤨 How would YOU manage her T-DXd therapy?
Back to our case🔎
🩻 CT CAP after 12 wks:
Partial response in liver, stable bone mets, new consolidation and GGO in B/L lower lobes
👩 Patient denies SOB, cough, or fever
🤨 How would YOU manage her T-DXd therapy?
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @dradityabardia @IlanaSchlam 15/18 #TumorBoardTuesday #BCSM
📌Management of suspected T-DXd ILD
🙅Hold drug
📝Workup (O2, high-res CT, labs, etc)
👨⚕️Consider resp consult
👺Steroids as clinically indicated
🩻Repeat CTs to assess resolution
🫁G1 ILD: Consider T-DXd restart once resolved
🫁G2+ ILD: D/C T-DXd
📌Management of suspected T-DXd ILD
🙅Hold drug
📝Workup (O2, high-res CT, labs, etc)
👨⚕️Consider resp consult
👺Steroids as clinically indicated
🩻Repeat CTs to assess resolution
🫁G1 ILD: Consider T-DXd restart once resolved
🫁G2+ ILD: D/C T-DXd
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 16/18 #TumorBoardTuesday #BreastCancer
📌5 S rules: key practices for detection & management of ILD
📊Screen baseline risk
🩻Scan q6-12wk
🤝Synergy: pts + team
🫁Suspend T-DXd if suspect ILD
🫁Admin steroids in case of ILD
📚@PTarantinoMD @stolaney1 ascopubs.org
📌5 S rules: key practices for detection & management of ILD
📊Screen baseline risk
🩻Scan q6-12wk
🤝Synergy: pts + team
🫁Suspend T-DXd if suspect ILD
🫁Admin steroids in case of ILD
📚@PTarantinoMD @stolaney1 ascopubs.org
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 17/18 #TumorBoardTuesday #BreastCancer
🙋🏼♀️Evolution of defining of HER2-low?
🎯If DB06 expands targetability to HER2-ultra low
🧪If quantitative HER2 assays are validated ➡️ expand to the full spectrum of expression!
📚@PTarantinoMD @CD_AACR aacrjournals.org
🙋🏼♀️Evolution of defining of HER2-low?
🎯If DB06 expands targetability to HER2-ultra low
🧪If quantitative HER2 assays are validated ➡️ expand to the full spectrum of expression!
📚@PTarantinoMD @CD_AACR aacrjournals.org
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 @CD_AACR 18/18 #TumorBoardTuesday
Back to our case🔎
👩Pt dx with G1 T-DXd ILD
💊Per resp suggestion, started on oral pred to ⬇️ risk of progression
🙌🏽Remains asymptomatic at visit 1 wk later
🙏🏼ILD resolved on CT 2 wks later
✅Multidisciplinary #SharedDecision made to restart T-DXd
Back to our case🔎
👩Pt dx with G1 T-DXd ILD
💊Per resp suggestion, started on oral pred to ⬇️ risk of progression
🙌🏽Remains asymptomatic at visit 1 wk later
🙏🏼ILD resolved on CT 2 wks later
✅Multidisciplinary #SharedDecision made to restart T-DXd
@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 #PostTest Q1️⃣ #TumorBoardTuesday
👉🏽#CME Eval 🔗 integrityce.com
👉🏽ALL CME🔗 integrityce.com
🤔@PTarantinoMD @MeganTesch taught us about HER2 low mBC, now test your 🧠
🧐What therapy?
58yo 👩🏼🦳
HR+, HER2- (IHC 1+), ESR1-
📅met progress 6mos post 2L of ET & cap?
👉🏽#CME Eval 🔗 integrityce.com
👉🏽ALL CME🔗 integrityce.com
🤔@PTarantinoMD @MeganTesch taught us about HER2 low mBC, now test your 🧠
🧐What therapy?
58yo 👩🏼🦳
HR+, HER2- (IHC 1+), ESR1-
📅met progress 6mos post 2L of ET & cap?
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@TumorBoardTues @PTarantinoMD @IntegrityCE @JanssenUS @AstraZeneca @drsarahsam @vitti10 @Mattia_Rediti @lab_kok @angela_toss @elmayermd @puglisi_fabio @BianchiniGP @GiuseppeBuono88 @JavierCortesMD @WaterfordMafia @DraAnaCasas @FAndreMD @ArielleMedford @jane_meisel @nlinmd @DSoldatoMD @maryam_lustberg @JAMouabbi @DrGattiMays @LoiSher @BarYaelMD @MPishvaian @JohnEbbenMDPhD @4RiseUp @DrSGraff @awolff @brunovalsi @KoontzOncology @sardesai_sagar @CharlesMilrod @christeeny513 @prarthnavb @quirogad @aditihazra @conni_t212 @EmperorBlackMD @CarmenCriscit @Rodrosb @MVanMeterMD @GaiaGriguolo @aftimosp @FrancescoSche20 #PostTest Q2️⃣ #TumorBoardTuesday #BCSM #BreastCancer
👉🏽 Free CME 🔗integrityce.com
🧐 What percentage of HER2- (IHC 0) primary tumors were found to be HER2-low at relapse in a study of primary & relapsed breast tumors?
👉🏽 Free CME 🔗integrityce.com
🧐 What percentage of HER2- (IHC 0) primary tumors were found to be HER2-low at relapse in a study of primary & relapsed breast tumors?
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