1. Case Discussion
A 35-year-old woman presented with a 1.1-cm palpable lesion in the breast
Biopsy revealed ER-/PR-positive, HER2-positive
Would you recommend neoadjuvant therapy?
Would you include pertuzumab?

2. Approach to Sentinel Node Resection in a Patient with Pathologic Response to Neoadjuvant Therapy
“Even if the nodes are clearly involved, even if they’re biopsy proven before we start treatment, we do our best to clip the node from which the biopsy came to make sure we can actually remove that specific node during the sentinel node procedure. And providing there is pathological remission there, even if there’s a lot of scarring, even if you know the node was involved initially, we would not do axillary node resection. But I’ve got to say it’s a controversial area.” Ian E Smith, MD

3. Case Discussion
A 35-year-old woman presented with a 1.1-cm palpable lesion in the breast
Biopsy revealed ER-/PR-positive, HER2-positive

4. TCHP + endocrine therapy TCHP + endocrine therapy
NSABP-B-52: A Phase III Trial of Neoadjuvant Therapy for HR-Positive/HER2-Positive Breast Cancer
TCHP
Eligibility (N = 315)
Locally advanced invasive BC
HR-positive/HER2-positive
No evidence of metastatic disease R
TCHP + endocrine therapy
Outcome in evaluable pts (n = 308)
TCHP
TCHP + endocrine therapy
p-value
pCR (breast & nodes)
40.9%
46.1%
0.36
pCR (breast)
44.2%
47.4%
0.57
Rimawi MF et al. Proc SABCS 2016;Abstract S3-06.

5. Case Discussion
A 76-year-old frail-looking woman presented with a 6-cm breast tumor
Patient weighs 99 lbs
Biopsy revealed ER-/PR-negative, HER2-positive disease
Nipple retraction with palpable axillary node, but the biopsy was negative
Would you recommend an anthracycline- containing neoadjuvant therapy?
Would you include pertuzumab? If so, at what dose?

6. Tolerability of Pertuzumab in Elderly, Frail Patients
“Diarrhea is the main problem. Usually it’s just for a few days and it’s tolerable or you can cope with it with antidiarrheals… if I were going to treat this elderly patient, this very small patient, with a standard dose, I would be very cautious and supervise her very carefully and keep in close touch with her about the possibility of diarrhea, because that would not be much fun in a fairly poor 76-year-old.” Ian E Smith, MD

7. Case Discussion
A 53-year-old woman with an ER-/PR-negative, HER2-positive tumor
Patient opted for immediate surgery and refused neoadjuvant therapy
Biopsy revealed a 2.5-cm node-negative tumor
Patient now has recurrent disease postop
Would you recommend adjuvant pertuzumab therapy? If so, which regimen?

8. NeoSphere: Analysis of Neoadjuvant Pertuzumab and Trastuzumab
Trastuzumab (H) + docetaxel (T)
Eligibility (N = 417)
Patients with locally advanced, inflammatory or early-stage breast cancer
HER2-positive disease
Pertuzumab (P) + H + T R
P + H
P + T
Outcome
H + T
(n = 107)
P + H + T
P + H
P + T
(n = 96)
pCR
29.0%
45.8%
16.8%
24.0%
5-year PFS
81%
86%
73%
5-year DFS
84%
80%
75%
Gianni L et al. Lancet Oncol 2016;17(6): ; Lancet Oncol 2012;13(1):25-32.

9. Case Discussion A 67-year-old man with invasive ductal carcinoma
Biopsy revealed ER-positive, HER2-positive disease
He underwent mastectomy and sentinel node resection  TCH  trastuzumab x 1 y  tamoxifen
He developed respiratory problems on tamoxifen and discontinued therapy
Patient’s disease has been rechallenged with tamoxifen 3 times, but each time, respiratory issues recur
Would you recommend adjuvant AI therapy?

10. Case Discussion
A 78-year-old asymptomatic woman presents with de novo breast cancer and lung metastases
Biopsy revealed HER2-positive disease
Would you recommend endocrine therapy in combination with dual HER2-directed therapy?

11. Case Discussion A 70-year-old woman with HER2-positive breast cancer
She participated in 2 randomized Phase III trials but did not receive the HER2-targeted agent on either
The Phase III SWOG-N9831 adjuvant trial of AC  weekly paclitaxel +/- trastuzumab for patients with HER2-positive, N+ or high-risk N- breast cancer
The Phase III TEACH adjuvant trial of lapatinib versus placebo for patients with HER2-positive Stage I-IIIC invasive breast cancer
Eventually, she developed metastatic disease
She received T-DM1, with ongoing complete clinical response for 5+ years

12. Case Discussion A 35-year-old woman with Stage II breast cancer
Biopsy revealed ER-/PR-negative, HER2-positive disease
She received adjuvant AC  TH
After 2 years, she developed ER-/PR-negative, HER2- positive isolated breast recurrence  surgery
Would you recommend chemotherapy in combination with trastuzumab and pertuzumab?

13. Choice of Chemotherapy for Anthracycline- or Taxane-Ineligible Candidate
“There is no standard of choice if you’re not using anthracyclines and taxanes. There’s no guideline. There are no good data. But if you look at all the early work that was done on trastuzumab, both neoadjuvant studies and in metastatic disease, whatever chemotherapy was used — there were a lot of Phase II studies, nonrandomized. And they all produced high response rates. And there was almost a message that whatever chemotherapy you’re going to use with trastuzumab is going to have a positive synergistic effect.” Ian E Smith, MD

14. Case Discussion
A 55-year-old woman was diagnosed with breast cancer and metastases to the liver and bone 4 years ago
Patient initially received chemotherapy/trastuzumab in combination with pertuzumab  trastuzumab/pertuzumab maintenance
Patient is still on trastuzumab/pertuzumab maintenance (+ 4 years)
For how long should trastuzumab/pertuzumab maintenance be used?

15. Case Discussion
A 64-year-old somewhat frail woman was diagnosed with ER-positive, HER2-negative breast cancer
Patient had multiple positive nodes
The Oncotype DX® Recurrence Score® was  docetaxel/cyclophosphamide
One year later, she developed hepatic lesions, biopsy proven as ER-positive/HER2-negative
She received multiple regimens  complete remission
One year later, she developed new hepatic lesions, biopsy proven with NGS as HER2-positive  capecitabine and trastuzumab  complete response
How often should a patient undergo a biopsy during the course of the disease?

16. SAFIR01/UNICANCER: Comparative Genomic Analysis in Metastatic Breast Cancer (mBC)
N = 423 patients
A targetable genomic alteration was identified in: (46%)
Therapy could be personalized in: 55 (13%)
Of the 43 patients who were assessable and received targeted therapy:
Objective response: 4 (9%)
Stable disease >16 weeks: 9 (21%)
Andre F et al. Lancet Oncol 2014;15(3):

17. Approach to Repeat Biopsies
“It’s not so easy to keep doing tumor biopsies. But, of course, it’s very easy indeed to keep doing blood sampling… The other question, which is looking very exciting, is that we can pick up recurrence a considerable length of time before you can with routine standard measurements, because the tumor DNA appears in the blood or arises in the blood several months before there’s any other evidence of relapse.” Ian E Smith, MD

18. Case Discussion
A 60-year-old woman with a history of triple-negative breast cancer and sternal metastasis
She received radiation therapy and multiple chemotherapy regimens  surgical resection  R0 margin
Is this treatment strategy justified?
How would you have approached the treatment of this patient?

19. Case Discussion
A 60-year-old woman with a history of triple-negative breast cancer and sternal metastasis
She received radiation therapy and multiple chemotherapy regimens  surgical resection  R0 margin
If she experiences disease progression in the future, what treatment approach would you recommend?

20. JAVELIN: A Phase Ib Trial of Avelumab
Eligibility (N = 1,706)
Patients with locally advanced or metastatic solid tumors
Avelumab
10 mg/kg, q2wk
ORR
N = 168
All patients (n = 168)
5.4%
PD-L1+ mBC
33.3%
PD-L1+ triple-negative breast cancer
44.4%
Dirix LY et al. Proc SABCS 2015;Abstract S1-04.

21. Case Discussion
A 60-year-old woman with a history of triple-negative breast cancer and sternal metastasis
She received radiation therapy and multiple chemotherapy regimens  surgical resection  R0 margin
If she experiences disease progression in the future, would you consider antiandrogen therapy?

22. Case Discussion
A 60-year-old woman with a history of triple-negative breast cancer and sternal metastasis
She received radiation therapy and multiple chemotherapy regimens  surgical resection  R0 margin
If she experiences disease progression in the future, what treatment approach would you recommend?

23. Case Discussion
A 41-year-old woman with a 1.6-cm ER-positive, HER2-negative breast tumor
Biopsy revealed 1 positive axillary node
Ki-67 of 50%
How do you approach neoadjuvant therapy for ER-positive, HER2-negative breast cancer?

24. CREATE-X: A Phase III Trial of Adjuvant Capecitabine for HER2-Negative Breast Cancer with Residual Invasive Disease
Survival
Capecitabine
(n = 440)
Control
(n = 445) HR
p-value
5-year DFS
74.1%
67.7%
0.70
5-year OS
89.2%
83.9%
0.60
0.01
DFS by hormone receptor (HR) status
HR-positive
(n = 281, 280) NR
0.84
HR-negative
(n = 147, 149)
0.58
NR = not reported
Toi M et al. Proc SABCS 2015;Abstract S1-07.

25. CREATE-X: A Phase III Trial of Adjuvant Capecitabine for HER2-Negative Stage I-IIIB Breast Cancer
2,500 mg/m2/day, d1-14
(n = 440)
Neoadjuvant chemo
Surgery
Pathology
Non-pCR or node+ R
Control
(n = 445)
Primary endpoint: DFS
Outcome
Capecitabine
(n = 440)
Control
(n = 445) HR
p-value
5-year DFS
74.1%
67.7%
0.70
5-year OS
89.2%
83.9%
0.60
0.01
Subgroup analysis of DFS for pts with HR-negative disease (n = 296): HR = 0.58
Toi M et al. Proc SABCS 2015;Abstract S1-07.

26. Case Discussion
A 71-year-old woman with ER-positive, HER2- negative breast cancer
Biopsy revealed 3 positive sentinel nodes
High 70-gene signature Recurrence Score
How do you interpret the 70-gene signature Recurrence Score in the absence of Adjuvant! Online?

27. MINDACT: 70-Gene Signature Test (MammaPrint®) as an Aid to Treatment Decisions in Early-Stage BC
Survival without distant metastasis
At 5 years
Low clinical/genomic risk (n = 2,745)
97.6%
High clinical/low genomic risk (n = 1,550)
95.1%
Low clinical/high genomic risk (n = 592)
94.8%
High clinical/high genomic risk (n = 1,806)
90.6%
Cardoso F et al. N Engl J Med 2016;375(8):

28. PlanB Phase III Trial: Prospective Outcome Data for the 21-Gene Recurrence Score (RS) Assay
3-year DFS
N = 3,198
Patients with RS ≤11 who received endocrine therapy alone
98%
Patients with RS who received chemotherapy
Patients with RS >25 who received chemotherapy
92%
Univariate prognostic factors for DFS:
Nodal status, central and local grade, the Ki-67 protein encoded by the MKI67 gene, ER, PR, tumor size and RS
Gluz O et al. J Clin Oncol 2016;34(20):

29. Case Discussion
A 63-year-old woman presents with a 1.5-cm node- negative, ER-positive, HER2-negative breast cancer
She received TC x 4 cycles  anastrozole for 5 years
Would you continue endocrine therapy after 5 years?

30. TAILORx: Outcomes in Patients with Hormone Receptor-Positive, HER2-Negative Breast Cancer Treated with Endocrine Therapy Alone
Outcomes in patients with RS<11
N = 1,626
5-year invasive DFS
93.8%
Freedom from BC recurrence at 5 years
Distant site
Distant or local-regional site
99.3%
98.7%
5-year OS
98.0%
Sparano JA et al. N Engl J Med 2015;373(21):

31. EBCTCG Analysis: Risk of Distant Recurrence by Tumor and Nodal Status
Subgroup
10 years
15 years
20 years
T1N0 4% 9%
14%
T1N1 (1-3 nodes) 8%
15%
23%
T1N2 (4-9 nodes)
16%
30%
41%
T2N0
21%
T2N1 (1-3 nodes)
12%
20%
29%
T2N2 (4-9 nodes)
35%
47%
Pan H et al. Proc ASCO 2016;Abstract 505.

32. EBCTCG Analysis: Relative Risk of Distant Recurrence
Data from 91 trials with 46,138 women with ER-positive BC, alive and disease free after 5 y of endocrine therapy
Prognostic factor
Relative risk
Nodal status (N1-3 vs N0)
2.08
Tumor stage (T2N0 vs T1N0)
1.73
Grade (high vs low)
2.02
Ki-67 (≥20% vs 0-13%)
1.63
Pan H et al. Proc ASCO 2016;Abstract 505.

33. Case Discussion
A 63-year-old woman presents with a 1.5-cm node- negative, ER-positive, HER2-positive breast cancer
She received adjuvant trastuzumab in combination with chemotherapy  anastrozole
Would you consider continuing endocrine therapy after 5 years?

34. Case Discussion
A 60-year-old woman presents with a neglected locally advanced ulcerating PR-positive, HER2- negative tumor
CT scans reveals multiple lesions difficult to access for biopsy
The disease looks suspicious for metastases in soft tissue and bone
Which systemic therapy would you recommend for this patient?

35. Ribociclib/letrozole
Phase III MONALEESA-2 Trial of First-Line Ribociclib: Select Adverse Events
Event
Ribociclib/letrozole
(n = 334)
Placebo/letrozole
(n = 330)
Any
Grade 3
Grade 4
Neutropenia
74.3%
49.7%
9.6%
5.2%
0.9% 0%
Febrile neutropenia
1.5% NR
Infections
50.3%
3.6%
0.6%
42.4%
2.1%
0.3%
NR = not reported
Hortobagyi GN et al. N Engl J Med 2016;375(18):

36. FALCON: Phase III Trial Results
Fulvestrant
(n = 230)
Eligibility (N = 462)
Locally advanced or metastatic breast cancer
ER-/PR-positive disease R
Anastrozole
(n = 232)
Median PFS
Fulvestrant
Anastrozole HR
Pts with visceral disease
(n = 135, 119)
13.8 mo
15.9 mo
0.99
Pts without visceral disease
(n = 95, 113)
22.3 mo
0.59
Robertson JF et al. Lancet 2016;388(10063):

37. MONALEESA-2: Efficacy Results
All patients1
Ribociclib + letrozole
(n = 334)
Placebo + letrozole HR
p-value
Median PFS
Not reached
14.7 mo
0.56
3.29 x 10-6
Patients with de novo disease2
n = 114
n = 113
12-mo PFS
82%
66%
0.44 NR
NR = not reported
1 Hortobagyi GN et al. N Engl J Med 2016;375(18): ;
2 O’Shaughnessy J et al. Proc SABCS 2016;Abstract P

38. Case Discussion
A 60-year-old woman presents with a neglected locally advanced ulcerating PR-positive, HER2- negative tumor
CT scans reveals multiple lesions difficult to access for biopsy
The disease looks suspicious for metastases in soft tissue and bone
Which systemic therapy would you recommend for this patient?

39. Case Discussion
A 30-year-old woman with ER-positive, HER2- negative, node-positive breast cancer
She is reluctant to receive adjuvant chemotherapy
The Oncotype DX Recurrence Score is 52
An emergency room visit resulted in a biopsy, which revealed liver metastases
Which systemic therapy would you recommend for this patient?

40. Case Discussion
A 30-year-old woman with ER-positive, HER2- negative, node-positive breast cancer
She is reluctant to receive adjuvant chemotherapy
The Oncotype DX Recurrence Score is 52
An emergency room visit resulted in a biopsy, which revealed liver metastases
Which systemic therapy would you recommend for this patient?

41. Case Discussion
A 72-year-old woman is diagnosed with diffuse metastatic breast cancer
Biopsy revealed ER-positive, HER2-negative disease with a BRCA2 germline mutation
She has received multiple treatment regimens for ER-positive/HER2-negative disease
Would you consider treatment with a PARP inhibitor?

42. Personal Approach to PARP Inhibitor Therapy for BRCA Mutation–Positive Breast Cancer
“I do think it’s quite reasonable based on the data. All of the single-agent PARP inhibitor trials in BRCA germline — 1 or 2 germline mutations all show a robust level of response that really support it going forward into the Phase III trials that have either finished accrual or very close to finishing accrual. All of the PARP inhibitors are into randomized trials of PARP inhibitor versus chemotherapy of physician’s choice. So all of the level of activity was good enough to support those Phase III. So yes, I think for these patients, it’s a very reasonable option. It’s going to be great, of course, once we have 1 or 2 of them approved for breast cancer.” Joyce O’Shaughnessy, MD

43. ENGOT-OV16/NOVA: A Phase III Trial of Niraparib Maintenance in Ovarian Cancer
Niraparib 300 mg QD until PD
Germline BRCA mutation (n = 203) R
Eligibility (N = 553)
Platinum-sensitive, recurrent ovarian cancer
≥2 platinum-based regimens
Placebo
2:1
Niraparib 300 mg QD until PD
No germline BRCA mutation* (n = 350) R
Primary Endpoint: PFS
Placebo
2:1
* Patient tumors were tested for homologous recombination deficiency (HRD)
Mirza MR et al. N Engl J Med 2016;375(22): ; Proc ESMO 2016;Abstract LBA3_PR.

44. ENGOT-OV16/NOVA: Efficacy Results
Median PFS
Niraparib
Placebo HR
p-value
Germline BRCA mutation (n = 138, 65)
21.0 mo
5.5 mo
0.27
<0.001
No germline BRCA mutation (n = 234, 116)
9.3 mo
3.9 mo
0.45
No germline BRCA mutation with HRD positivity (n = 106, 56)
12.9 mo
3.8 mo
0.38
Mirza MR et al. N Engl J Med 2016;375(22): ; Proc ESMO 2016;Abstract LBA3_PR.

45. ENGOT-OV16/NOVA: Efficacy Results
Median PFS
Niraparib
Placebo HR
p-value
Germline BRCA mutation (n = 138, 65)
21.0 mo
5.5 mo
0.27
<0.001
No germline BRCA mutation (n = 234, 116)
9.3 mo
3.9 mo
0.45
No germline BRCA mutation with HRD negative disease (n = 92, 42)
6.9 mo
3.8 mo
0.58
0.02
Mirza MR et al. N Engl J Med 2016;375(22): ; Proc ESMO 2016;Abstract LBA3_PR.

46. View on the Effectiveness of Sequencing PARP Inhibitor Therapy After a Platinum-Based Regimen
“PARP inhibitors basically stop that DNA repair, single-strand break repair… The PARP inhibitors as well can interfere with homologous recombination itself. But they basically inhibit a leg of the DNA repair mechanisms. And these cancers, they can’t be cancers unless they have DNA repair deficiency. So they already have a problem. And when you come in with platinum, you are putting a lot of stress on the base excision repair pathway, and you overwhelm it. You overwhelm it with platinum. And with the PARP inhibitors, you inhibit base excision repair and homologous recombination, to some extent, and other pathways as well.” Joyce O’Shaughnessy, MD

47. Case Discussion
A 65-year-old woman is diagnosed with a 3.5-cm breast tumor
Biopsy reveals ER-positive, HER2-negative, node- positive breast cancer
She is currently receiving neoadjuvant letrozole in combination with palbociclib on the NSABP-FB-11 trial (PALLET)
If the patient achieves pCR in sentinel lymph nodes, how do you approach the axilla?

48. Ongoing ALTERNATE Phase III Neoadjuvant Trial
Anastrozole
Target (N = 2,820)
Postmenopausal women with ER-positive/HER2- negative IDC
cT2-4 N0-3 M0 breast cancer R
Fulvestrant
Anastrozole + fulvestrant
Primary outcome measures: Rate of endocrine-resistant disease, pCR and recurrence-free survival
Suman VJ et al. Chin Clin Oncol 2015;4(3):34; Clinicaltrials.gov; NCT

49. Case Discussion A 51-year-old woman with a 3-cm breast tumor
Biopsy reveals strongly ER-/PR-positive, HER2- negative breast cancer
The axilla is clinically negative, but PET/MRI scans show increased uptake in the spine and marrow changes without FDG activity
Patient underwent a mastectomy, and core biopsy of the iliac crest revealed metastatic disease with 12/12 positive nodes
What therapeutic approach would you take?

50. Case Discussion
A 58-year-old postmenopausal woman with a 5-cm invasive lobular breast cancer
Biopsy revealed ER-/PR-positive, HER2-negative disease
The surgeon would like to know if breast conservation surgery is an option for the patient.
Which would you recommend: hormonal therapy or chemotherapy or treatment decision post genomic assay results?

51. Case Discussion
A 58-year-old postmenopausal woman with a 5-cm invasive lobular breast cancer
Biopsy revealed ER-/PR-positive, HER2-negative disease
The surgeon would like to know if breast conservation surgery is an option for the patient.
Are there clinical situations in which you would consider other options besides chemotherapy for this patient?

52. Case Discussion
A 45-year-old woman with ER-positive, HER2- negative ductal carcinoma
The surgeon would like to know if breast conservation surgery is an option for the patient.
Would you consider endocrine therapy or make a treatment decision after genomic assay results?

53. Using the 21-Gene Assay from Core Needle Biopsies to Select Neoadjuvant Therapy for Breast Cancer
Treatment group
RS<11 NHT (n = 12)
RS NHT (n = 18)
RS NCT (n = 11)
RS>25 NCT (n = 14) CR
83.3%
50%
72.7%
92.9%
pCR (breast)
8.3% 6%
21.4%
pCR (breast and nodes)
14.3%
Successful BCS
75%
72.2%
63.6%
57.1%
NHT = neoadjuvant hormonal therapy
NCT = neoadjuvant chemotherapy
CR = clinical CR + clinical PR
BCS = breast-conserving surgery
Bear HD et al. Proc SABCS 2016;Abstract P

54. Approach to Chemotherapy for Premenopausal Patients with ER-positive, HER2-Negative Breast Cancer
“I don’t think we have enough data yet in most premenopausal, ER-positive, either larger cancers or node-positive cancers to leave chemotherapy off most of those patients, because really, if you’re in the adjuvant setting when you have all the data in front of you, you know exactly how large it is. You know the nodal status. You know on your Ki-67 whether there’s heterogeneity, because when they read the Ki-67s, they’ll say, ‘Oh, 10% to 15%, but there’s focal areas up to 25%, 30%.’ Those are your lethal subclones. And when you’re just doing a little needle biopsy up front, you don’t have all the answers there, basically.” Joyce O’Shaughnessy, MD

55. Case Discussion
A patient in her 50s presents with ER-positive breast cancer with bone and nodal metastases
After 8 months of receiving letrozole and palbociclib, she experiences disease progression
At the patient’s insistence, palbociclib is continued but in combination with fulvestrant  disease progression after a couple of months
Should this patient receive chemotherapy or exemestane/everolimus?

56. Case Discussion
A patient in her 50s presents with ER-positive breast cancer with bone and nodal metastases
After 8 months of receiving letrozole and palbociclib, she experiences disease progression
At the patient’s insistence, palbociclib is continued but in combination with fulvestrant  disease progression after a couple of months

57. Case Discussion
A 59-year-old postmenopausal woman presents with a 6-cm inflammatory breast cancer in 2014
Biopsy revealed ER-positive, HER2-negative, clinically node-negative disease
Patient received neoadjuvant dose-dense AC/paclitaxel  surgery, but with residual disease
She receives adjuvant anastrozole x 1 year  bone metastases  multiple therapies including palbociclib
What would be your next treatment approach?

58. Case Discussion
A 59-year-old postmenopausal woman presents with a 6-cm inflammatory breast cancer in 2014
Biopsy revealed ER-positive, HER2-negative, clinically node-negative disease
Patient received neoadjuvant dose-dense AC/paclitaxel  surgery, but with residual disease
She receives adjuvant anastrozole x 1 year  bone metastases  multiple therapies including palbociclib, which was not well tolerated
Dose reduce palbociclib to manage neutropenia

59. Case Discussion
A 59-year-old postmenopausal woman presents with a 6-cm inflammatory breast cancer in 2014
Biopsy revealed ER-positive, HER2-negative, clinically node-negative disease
Patient received neoadjuvant dose-dense AC/paclitaxel  surgery, but with residual disease
She receives adjuvant anastrozole x 1 year  bone metastases  multiple therapies including palbociclib
She develops tolerability issues to treatment  more disease progression
What would be your next treatment approach?

60. Case Discussion
A 68-year-old woman presents with 3 primary breast tumors; 2 on one side and 1 on the other
Biopsy revealed ER-positive, HER2-negative and BRCA2 germline mutation-positive disease
Patient underwent bilateral mastectomies
On one side: sentinel node was negative
On other side: 18/19 positive nodes
What therapy would you recommend for this patient with high-risk disease and a BRCA2 germline mutation?

61. Importance of Genetic Testing
For all patients with a family history of BRCA mutations, I rescreen them for these mutations, even though they tested negative in the past. Joyce O’Shaughnessy, MD

62. Importance of Genetic Testing
For all patients with a family history of BRCA mutations, I rescreen them for these mutations, even though they tested negative in the past.
The NCCN has come out with some helpful early guidance on what do you do if it’s a PALB2 or an ATM mutation.
The bottom line is: if you have more than a 20% lifetime risk of breast cancer with one of these other germline mutations, MRIs are being recommended
Joyce O’Shaughnessy, MD

63. Importance of Genetic Testing
For all patients with a family history of BRCA mutations, I rescreen them for these mutations, even though they tested negative in the past.
The NCCN has come out with some helpful early guidance on what do you do if it’s a PALB2 or an ATM mutation.
The bottom line is: if you have more than a 20% lifetime risk of breast cancer with one of these other germline mutations, MRIs are being recommended
Luckily, all patients are able to afford to pay for these tests out of pocket, even if costs are uncovered through insurance.
Joyce O’Shaughnessy, MD