The Impact of BRCA Status on Therapy Choices

Drs Lidia Schapira and Norah Lynn Henry discuss adjuvant endocrine therapy. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/969538). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources Adjuvant Endocrine Therapy for Women With Hormone Receptor–Positive Breast Cancer: ASCO Clinical Practice Guideline Focused Update https://ascopubs.org/doi/10.1200/JCO.18.01160 Evidence-Based Approaches for the Management of Side-Effects of Adjuvant Endocrine Therapy in Patients With Breast Cancer https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30666-5/fulltext Acupuncture for Arthralgia-Induced by Aromatase Inhibitors in Patients With Breast Cancer: A Systematic Review and Meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883140/ Long-Term Results From a Randomized Blinded Sham- and Waitlist-Controlled Trial of Acupuncture for Joint Symptoms Related to Aromatase Inhibitors in Early Stage Breast Cancer (S1200) https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.12018 Adverse Events and Perception of Benefit From Duloxetine for Treating Aromatase Inhibitor-Associated Arthralgias https://academic.oup.com/jncics/article/5/2/pkab018/6130825 Predictors of Aromatase Inhibitor Discontinuation as a Result of Treatment-Emergent Symptoms in Early-Stage Breast Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341106/ Active Symptom Monitoring and Endocrine Therapy Persistence in Young Women With Breast Cancer https://maps.cancer.gov/overview/DCCPSGrants/abstract.jsp?applId=10337861&term=CA266012 Patient-Reported Outcomes and Early Discontinuation in Aromatase Inhibitor-Treated Postmenopausal Women With Early Stage Breast Cancer https://academic.oup.com/oncolo/article/21/5/539/6401566?login=false Effect of a Switch of Aromatase Inhibitors on Musculoskeletal Symptoms in Postmenopausal Women With Hormone-Receptor-Positive Breast Cancer: The ATOLL (Articular Tolerance of Letrozole) Study https://pubmed.ncbi.nlm.nih.gov/20035381/ Benefits of Digital Symptom Monitoring With Patient-Reported Outcomes During Adjuvant Cancer Treatment https://ascopubs.org/doi/full/10.1200/JCO.20.03375 Cohort Study of Adherence to Adjuvant Endocrine Therapy, Breast Cancer Recurrence and Mortality https://www.nature.com/articles/bjc2013116 Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493485/ Caution: Vaginal Estradiol Appears to Be Contraindicated in Postmenopausal Women on Adjuvant Aromatase Inhibitors https://www.annalsofoncology.org/article/S0923-7534(19)57558-5/fulltext Management of Genitourinary Syndrome of Menopause in Breast Cancer Survivors: An Update https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894268/

Drs Lidia Schapira and Kevin Kalinsky discuss the RxPONDER trial and immunotherapy. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963171). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer https://www.nejm.org/doi/10.1056/NEJMoa2108873 Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193457/ Randomized Comparisons of Adjuvant Aromatase Inhibitor Exemestane Plus Ovarian Function Suppression vs Tamoxifen in Premenopausal Women With Hormone Receptor–Positive Early Breast Cancer: Update of the TEXT and SOFT Trials https://www.abstractsonline.com/pp8/#!/10462/presentation/645 Breast Cancer Index https://www.breastcancerindex.com/ Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2−, Node-Positive, High-Risk, Early Breast Cancer (monarchE) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768339/ Continuous Versus Intermittent Extended Adjuvant Letrozole for Breast Cancer: Final Results of Randomized Phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy https://linkinghub.elsevier.com/retrieve/pii/S0923-7534(21)02492-3 Event-free Survival With Pembrolizumab in Early Triple-Negative Breast Cancer https://www.nejm.org/doi/10.1056/NEJMoa2112651

Drs Lidia Schapira and Kathryn Ruddy discuss treatment and follow-up care for premenopausal women with breast cancer. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963169). The topics and discussions are planned, produced, and reviewed independently of advertiser. This podcast is intended only for US healthcare professionals. Resources MutYH Mutation Carriers Have Increased Breast Cancer Risk https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.26506 Kathryn J. Ruddy, MD, MPH Biography https://www.mayoclinic.org/biographies/ruddy-kathryn-j-m-d/BIO-20055748?_escaped_fragment_=&p=1 Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer https://www.nejm.org/doi/full/10.1056/nejmoa1804710 About Oncotype DX Breast DCIS Score https://www.oncotypeiq.com/en-US/breast-cancer/healthcare-professionals/oncotype-dx-breast-dcis-score/about-the-test Goserelin for Ovarian Protection During Breast-Cancer Adjuvant Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405231/ Adjuvant Ovarian Suppression in Premenopausal Breast Cancer https://www.nejm.org/doi/full/10.1056/NEJMoa1412379 Who Are the Women Who Enrolled in the POSITIVE Trial: A Global Study to Support Young Hormone Receptor Positive Breast Cancer Survivors Desiring Pregnancy https://www.sciencedirect.com/science/article/pii/S096097762100429X Pregnancy After Breast Cancer https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor/pregnancy-after-breast-cancer.html Pragmatic Cluster Randomized Trial to Evaluate Effectiveness and Implementation of Enhanced EHR-Facilitated Cancer Symptom Control (E2C2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275300/

Drs Lidia Schapira and Nadine Tung discuss how BRCA status affects choosing therapy for patients with early-stage breast cancer. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963168). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources TBCRC 031: Randomized Phase II Study of Neoadjuvant Cisplatin Versus Doxorubicin-Cyclophosphamide in Germline BRCA Carriers With HER2-Negative Breast Cancer (the INFORM trial) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462533/ Adjuvant Olaparib for Patients with BRCA1- or BRCA2-Mutated Breast Cancer https://www.nejm.org/doi/full/10.1056/NEJMoa2105215 Validation of a Novel Staging System for Disease-Specific Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107758/ Table 1 from Validation of a Novel Staging System for Disease-Specific Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107758/table/T1/?report=objectonly Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2−, Node-Positive, High-Risk, Early Breast Cancer (monarchE) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768339/ Evaluation of Efficacy and Safety of PARP Inhibitors in Breast Cancer: A Systematic Review and Meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8215282/pdf/main.pdf LYNPARZA® (olaparib) Prescribing Information. AstraZeneca; 2020. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/208558s014lbl.pdf Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline https://ascopubs.org/doi/full/10.1200/JCO.20.00299 A Population-Based Study of Genes Previously Implicated in Breast Cancer https://www.nejm.org/doi/full/10.1056/NEJMoa2005936 TBCRC 048: Phase II Study of Olaparib for Metastatic Breast Cancer and Mutations in Homologous Recombination-Related Genes https://ascopubs.org/doi/10.1200/JCO.20.02151 Cancer Risks and Mortality in Heterozygous ATM Mutation Carriers https://academic.oup.com/jnci/article/97/11/813/2521263?login=false Neoadjuvant Talazoparib in Patients With Germline BRCA1/2 (gBRCA1/2) Mutation-Positive, Early HER2-Negative Breast Cancer (BC): Results of a Phase 2 Study https://ascopubs.org/doi/abs/10.1200/JCO.2021.39.15_suppl.505

Drs Lidia Schapira and Antonio Wolff resume their discussion on the current research on DCIS and other forms of lower-risk early breast cancer, and how medical oncologists can work to create an optimal treatment plan. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963167). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2-, Node-Positive, High-Risk, Early Breast Cancer (monarchE) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768339/ Tamoxifen for early breast cancer: an overview of the randomised trials https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)11423-4/fulltext Adjuvant Palbociclib for Early Breast Cancer: The PALLAS Trial Results (ABCSG-42/AFT-05/BIG-14-03) https://ascopubs.org/doi/10.1200/JCO.21.02554?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Palbociclib for Residual High-Risk Invasive HR-Positive and HER2-Negative Early Breast Cancer—The Penelope-B Trial https://ascopubs.org/doi/10.1200/JCO.20.03639?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Verzenio® (abemaciclib) Significantly Reduced the Risk of Cancer Returning in People with High Risk HR+, HER2- Early Breast Cancer https://investor.lilly.com/news-releases/news-release-details/verzenior-abemaciclib-significantly-reduced-risk-cancer Pfizer Provides Update on Phase 3 PALLAS Trial of IBRANCE® (palbociclib) Plus Endocrine Therapy in HR+, HER2- Early Breast Cancer https://www.pfizer.com/news/press-release/press-release-detail/pfizer-provides-update-phase-3-pallas-trial-ibrancer NATALEE: Phase III study of ribociclib (RIBO) + endocrine therapy (ET) as adjuvant treatment in hormone receptor–positive (HR+), human epidermal growth factor receptor 2–negative (HER2–) early breast cancer (EBC). https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.15_suppl.TPS597 FDA Approval Summary: Abemaciclib With Endocrine Therapy for High-Risk Early Breast Cancer https://ascopubs.org/doi/full/10.1200/JCO.21.02742#:~:text=The%20US%20Food%20and%20Drug,%2D67%20score%20%E2%89%A5%2020%25. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study https://www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2821%2904494-X

Drs Lidia Schapira and Antonio Wolff discuss the current research on DCIS and other forms of lower-risk early breast cancer, and how medical oncologists can work to create an optimal treatment plan. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963165). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources Questions About the BRCA1 and BRCA2 Gene Study and Breast Cancer https://www.genome.gov/10000940/brca1brca2-study-faq Overcoming Barriers in Ductal Carcinoma In Situ Management: From Overtreatment to Optimal Treatment https://ascopubs.org/doi/10.1200/JCO.21.01674 Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474966/ Addressing Overtreatment of Screen Detected DCIS; The LORIS Trial https://www.ejcancer.com/article/S0959-8049(15)00697-8/fulltext Feasibility of a Prospective, Randomised, Open-label, International Multicentre, Phase III, Non-inferiority Trial to Assess the Safety of Active Surveillance for Low Risk Ductal Carcinoma In Situ -- The LORD study https://www.ejcancer.com/article/S0959-8049(15)00394-9/fulltext The COMET (Comparison of Operative versus Monitoring and Endocrine Therapy) Trial: A Phase III Randomised Controlled Clinical Trial for Low-Risk Ductal Carcinoma In Situ (DCIS) https://bmjopen.bmj.com/content/9/3/e026797.long

Drs Schapira and Gillespie begin this series by reviewing the current research on radiation options for early-stage breast cancer and how to discuss treatment options with patients. Relevant disclosures can be found with the episode show notes on Medscape.com (https://www.medscape.com/viewarticle/963162). The topics and discussions are planned, produced, and reviewed independently of our advertiser. This podcast is intended only for US healthcare professionals. Resources Radiation Therapy for the Whole Breast: Executive Summary of an American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline https://www.practicalradonc.org/article/S1879-8500(18)30051-1/fulltext Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526720/ Hypofractionated Breast Radiotherapy for 1 Week Versus 3 Weeks (FAST-Forward): 5-Year Efficacy and Late Normal Tissue Effects Results From a Multicentre, Non-inferiority, Randomised, Phase 3 Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30932-6/fulltext Partial-Breast Radiotherapy After Breast Conservation Surgery for Patients With Early Breast Cancer (UK IMPORT LOW trial): 5-Year Results From a Multicentre, Randomised, Controlled, Phase 3, Non-inferiority Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31145-5/fulltext External Beam Accelerated Partial Breast Irradiation Versus Whole Breast Irradiation After Breast Conserving Surgery in Women With Ductal Carcinoma In Situ and Node-Negative Breast Cancer (RAPID): A Randomised Controlled Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32515-2/fulltext Once Daily Versus Twice Daily External Beam Accelerated Partial Breast Irradiation: A Randomized Prospective Study https://www.redjournal.org/article/S0360-3016(20)34566-1/fulltext Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-term Results of the Randomized Phase III APBI-IMRT-Florence Trial https://ascopubs.org/doi/10.1200/JCO.20.00650 Acute and Short-term Toxic Effects of Conventionally Fractionated vs Hypofractionated Whole-Breast Irradiation: A Randomized Clinical Trial https://jamanetwork.com/journals/jamaoncology/fullarticle/2422117 De-escalation of Breast Radiation Trial for Hormone Sensitive, HER-2 Negative, Oncotype Recurrence Score Less Than or Equal to 18 Breast Cancer (DEBRA) https://clinicaltrials.gov/ct2/show/NCT04852887 Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer: Long-term Follow-up of CALGB 9343 https://ascopubs.org/doi/10.1200/JCO.2012.45.2615 PRIME II Investigators. Breast-Conserving Surgery With or Without Irradiation in Women Aged 65 Years or Older With Early Breast Cancer (PRIME II): A Randomised Controlled Trial https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)71221-5/fulltext Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 https://jamanetwork.com/journals/jama/fullarticle/2653737 Radiotherapy or Surgery of the Axilla After a Positive Sentinel Node in Breast Cancer (EORTC 10981-22023 AMAROS): A Randomised, Multicentre, Open-Label, Phase 3 Non-inferiority Trial https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70460-7/fulltext Regional Lymph Nodes Radiation and Breast Cancer Related Lymphedema: Where We Stand https://www.redjournal.org/article/S0360-3016(21)00165-6/fulltext Event-Free Survival With Pembrolizumab in Early Triple-Negative Breast Cancer https://www.nejm.org/doi/10.1056/NEJMoa1910549