| St.Gallen乳癌初期治療に関する コンセンサスカンファレンス International Consensus Conference on Primary Treatment of Breast Cancer 2015 |
速報！パネリスト投票結果 2015. 3.24
一部不明なところもあり、誤りがありましたらお知らせ下さい。
初めの方は、投票装置のトラブルのトラブルで、パネラー49人が挙手をして、数えるという事態になりました。
また、Eric Winer先生のアドリブで設問が変更されたり、新規に作ったりと、ついて行けなくなっているところもあり、
大変分かりづらいところも多いかと思いますが、ご勘弁下さい。
|
St. Gallen Oncology Conference 1.
Surgery of the Primary l In women undergoing breast conserving surgery for invasive BC and
proceeding to standard radiation and adjuvant systemic therapy the minimum acceptable surgical margin is: 1)
No ink on invasive tumor 75% → 91.9% 2)
1-2 mm clearance? 25% →
8.1% 3)
>2-5 mm clearance 0 → 0 4)
Margin is irrelaevant? 0 → 0 9)
Abstain
0 → 0 l Multifocal (unilateral) tumors can be treated with breast conservation
provided margins are clear and whole RT is planned. 1)
Yes 多 2)
No 少 9)
Abstain l Multicentric (unilateral) tumors can be treated with breast conservation
provided margins are clear and whole RT is planned. 1)
Yes 少 2)
No 多 9)
Abstain l Should the margin required be dependent on tumor biology? 2) No l Should the margin required be greater if age < 40? 2) No l Should the margin required be greater if lobular? 2) No l Should the margin required be greater after neoadjuvant therapy? 2) No l Should required margin be greater in presence of extensive
intraductal compeonent? 2) No l Should required margin be greater for pure DCIS than for invasive
disease? 1)
Yes <
2) No 2.
Surgery Following Neo-adjuvant
Chemotherapy In a patient who
is clinically node positive at presentation who downstages after chemotherapy: l Is SN Biopsy appropriate? 1)
Yes
> 2) No l Can ALND be avoided if 1 SN positive? 1)
Yes
25% < 2) No
75% l Can ALND be avoided if 2 SN positive? 2) No l Can ALND be avoided if > 2 SN positive? 2) No Should the
entire area of the original primary be resected after downstaging? 3.
Surgery of the Axilla In patients with macro-metastases in 1-2 sentinel nodes, completion
axillary dissection can safely be omitted following: l Mastectomy (no radiotherapy planned) 2) No l Mastectomy (radiotherapy planned) l 1) Yes <
2) No l Conservative resection with radiotherapy using standard tangents 1)
Yes 80%
> 2) No 20% l Conservative resection with radiotherapy using high tangents to
include the lower axilla 1)
Yes
95% > 2) No
5% 4.
Partial Breast Irradiation Following breast conserving surgery, partial breast irradiation may
be used: l As the definitive irradiation, without whole breast irradiation in
ASTRO/ESTRO “suitable” patients? 1)
Yes
85% > 2)
No 10% 9)
Abstain 5% l As the definitive irradiation, without whole breast irradiation in
ASTRO “cautionary” / ESTRO “intermediate” patients? 2)
No
> 9) Abstain l Only in the absence of adverse tumor pathology? (ASTRO/ESTRO guidelines allow any grade and are silent on multi-gene
tests) 1)
Yes
< 2) No
70% > 9)
Abstain. 5.
Hypofractionated Breast
Irradiation Following breast conserving surgery, hypofractionated whole breast
irradiation may be used in: l Patients aged 50 years or older without prior chemotherapy or
axillary lymph node involvement 1)
Yes
90% 9) Abstain 5% l Patients younger than 50 years 1)
Yes
80% 9) Abstain
20% l Those with prior chemotherapy or axillary lymph node involvement 1)
Yes
80% 9) Abstain
20% 6.
Regional node irradiation:
After Breast Conserving Surgery l Node positive 1)
Breast only l Node negative 1)
Breast only 0 2)
Breast + Regional node –
IMN 60% 3)
Breast + Regional node +
IMN 30% 9)
Abstain 10% 7.
Radiation Therapy: After
Mastectomy Should post mastectomy RT be standard for patients with: l T size >= 5 cm? 1)
Yes
95% > 2)
No 5% l N+ 1 to 3 all patients? 1)
Yes
35% 2) No
55% 9) Abstain 10% l N+ 1 to 3 with adverse pathology? 1)
Yes
90% 2) No
5% 9) Abstain
5% l N+ 1 to 3 at young age (<40 yrs)? 1)
Yes
45% 2) No
45% 9) Abstain
10% l Positive sentinel node biopsy but no axillary dissection? 1)
Yes
90% 2) No
5% 9) Abstain
5% l Micrometastasis in sentinel node biopsy but no axillary dissection? 1)
Yes
<< 2) No
95% 9) Abstain 5% l pN0 after axillary dissection without SNB and < 8 nodes examined? 1)
Yes
<< 2) No
95% 9) Abstain 5% 8.
Radiation Therapy: After
Mastectomy Following mastectomy, radiation if given should include: 1)
Chest wall only 11.4% 2)
Chest wall and regional nodes
but not IMN 40.9% 3)
Chest wall and regional nodes
including IMN 15.9% 9)
Abstain
31.8%
If RT is given following immediate breast reconstruction, it should
include: l Regional lymph node only 1)
Yes
13.3% 2) 62.2%
9) 24.4% l Nodes and the reconstructed breast: In most cases 1) Yes 54.8%
2) No 28.5% 9)
Abstain 16.7% Only with adverse pathological features 1)
Yes 37.5%
2) No 42.5%
9) Abstain 20% 9.
Radiation Following Neo-Adjuvant
Chemotherapy Approach to RT after neo-adjuvant therapy] l Should follow the stage before neo-adjuvant therapy? 1)
Yes
68.3% 2) 22%
9) 9.8% l Should follow the stage after neo-adjuvant therapy? 1) Yes
24.4 2) 65.9%
9) 9.8% 10. Pathology Distinction between ‘Luminal A-live’ and ‘Luminal B-like’ (HER2
neg.) can be: l Derived from ER, PgR and Ki-67? Ki-67 use requires knowledge of local lab values 1)
Yes
70.3% 2) No
13.5% 9) Abstain
13.5% l If used, the minimum value of Ki-67 required for ‘Luminal B-like’ is 1. 1 – 13 %
2.3% 2. 14 – 19 % 13.6% 3. 20 – 29 % 36.4% 4. 30 % or more
6.8% 5. Ki-67 should not be used for this distinction 20.5% 6. Abstain
2.3% l Only appropriately determined by multi-gene classifiers such as PAM50 or MammaPrint
/ BluePrint ? 1)
Yes
30.6% 2) No
66.7% 9) Abstain
2.8% Subtype need not
be determined since it can be replaced by risk scores derived from multi-gene
tests 1)
Yes 26.2%
2) No 59.5%
9) Abstain 14.3% Subtype need not
be determined since it can be replaced by risk scores derived from multi-gene
tests for chemotherapy in ER positive and HER2 negative, node negative 1)
Yes 55.6%
2) No 44.4%
9) Abstain 0 Should the
extent of lymphocytic infiltration be reported and used as: A prognostic marker
in TNBC and HER2 positive disease? 1)
Yes
25.6% 2) No
69.8% 9) Abstain 4.7% Should the
extent of lymphocytic infiltration be reported and used as: A predictive marker
in TNBC and HER2 positive disease? 1)
Yes
7.7% 2) No
89.7% 9) Abstain 2.6% 11. Multi-Gene Signatures In an endocrine-responsive cohort with high endocrine receptor level
±Ki-67 and negative HER2, clinically valuable additional information
on prognosis
and indication
for chemotherapy is provided by: l Oncotype DX RS Prognosis: years 1 – 5 ? 1) Yes 82.9%
2) No 14.6%
9) Abstain 2.4% Prognosis: beyond 5 yrs ? 1) Yes 43.9%
2) No 51.2%
9) Abstain 4.9% Chemotherapy ? 1) Yes 80.5%
2) No 14.6%
9) Abstain 4.9% l MammaPrint 70 Prognosis: years 1 – 5 ? 1) Yes 81% 2) No 9.5% 9) Abstain
9.5% Prognosis: beyond 5 yrs ? 1) Yes 19%
2) No 66.7%
9) Abstain 14.3% Chemotherapy ? 1) Yes 35%
2) No 47.5%
9) Abstain 17.5% l PAM-50 ROR score Prognosis: years 1 – 5 ? 1) Yes 92.9%
2) No 0% 9)
Abstain 7.1% Prognosis: beyond 5 yrs ? 1) Yes 63.2%
2) No 18.4%
9) Abstain 18.4% Chemotherapy ? 1) Yes 38.2%
2) No 47.1%
9) Abstain 14.7% l EndoPredict Prognosis: years 1 – 5 ? 1) Yes 70.3%
2) No 10.8%
9) Abstain 18.9% Prognosis: beyond 5 yrs ? 1) Yes 38.2%
2) No 38.2%
9) Abstain 23.5% Chemotherapy ? 1) Yes 23.5%
2) No 52.9%
9) Abstain 23.5% l Breast Cancer Index Prognosis: years 1 – 5 ? 1) Yes 58.3%
2) No 8.3%
9) Abstain 33.3% Prognosis: beyond 5 yrs ? 1) Yes 30.6%
2) No 30.6%
9) Abstain 38.9% Chemotherapy ? 1) Yes 10%
2) No 50% 9)
Abstain 36.7% 12. Endocrine Therapy: Premenopausal: ‘Typical’ Cases Age
42, node negative, grade 2, T1, no chemotherapy: 1.
Tam alone 85% 2.
OFS plus Tam 12.5% 3. OFS plus AI 0 4.
None of the above 2.5% 9.
Abstain 0 Age 34, node
positive, grade 3, T1, remaining premenopausal after adjuvant chemotherapy: 1.
Tam alone 2.3% 2.
OFS plus Tam 23.3% 3.
OFS plus exemestane 69.8% 4.
None of the above 2.3% 9.
Abstain 2.3% 10. 13. Endocrine Therapy:
Premenopausal: Selection Factors Factors arguing for including ovarian function suppression (OFS)
are: Age <=35 years 1) Yes 81%
2) No 19% 9)
Abstain 0% Premenopausal oestrogen level after adjuvant chemotherapy 1) Yes 73.7%
2) No 26.3%
9) Abstain 0% Grade 3 1) Yes 55.9%
2) No 38.2%
9) Abstain 0% Involvement of 4 or more nodes 1) Yes 89.7%
2) No 10.3%
9) Abstain 0% Adverse result of multi-gene test 1) Yes 60%
2) No 24.4%
9) Abstain 15.6% 14. Endocrine Therapy: Premonopausal: Selection Facors Factors
arguing for use of OFS + AI rather than OFS + tamoxifen are: Age <=35 years 1) Yes 59.4%
2) No 37.5%
9) Abstain 3.1% Premenopausal oestrogen level after adjuvant chemotherapy 1) Yes 43.9%
2) No 51.2%
9) Abstain 4.9% Grade 3 1) Yes 92.5%
2) No 5% 9)
Abstain 2.5% Involvement of 4 or more nodes 1) Yes 65.8%
2) No 31.5%
9) Abstain 2.6% Adverse result of multi-gene test 1) Yes 38.7%
2) No 58.1%
9) Abstain 3.2% 15. Endocrine Therapy: Postmenopausal Can
some patients be adequately treated with tamoxifen alone? 1) Yes 97.6%
2) No 2.4%
9) Abstain 0% Factors
arguing for inclusion of an AI at some pint are: Age < 60 1) Yes 31%
2) No 69% 9)
Abstain 0% Involvement of 4 or more nodes 1) Yes 97.6%
2) No 2.4%
9) Abstain 0% Grade 3 or high Ki-67 1) Yes 97.7%
2) No 2.3%
9) Abstain 0% HER2 positivity 1) Yes 71.1%
2) No 28.9%
9) Abstain 0% If and AI is
used, should it be started upfront: In all patients 1) Yes 47.5%
2) No 52.5%
9) Abstain 0% In patients at higher risk? 1) Yes 95.5%
2) No 4.5%
9) Abstain 0% Can upfront AI
be switched to TAM after 2 yrs? 1) Yes 75%
2) No 22.5%
9) Abstain 2.5% 16. Endocrine Therapy: Duration After
5 years of adjuvant Tam, continued AI, AI/OS or Tam to 10 years should be
recommended to: Premenopausal patients with node-positive disease? 1) Yes 100%
2) No 0% 9)
Abstain 0% Premenopausal patients with node-negative disease? 1) Yes 15.4%
2) No 4.4%
9) Abstain 10.3% Premenopausal patients with grade 3 or high Ki-67? 1) Yes 73.8%
2) No 21.4%
9) Abstain 4.8% Postmenopausal patients with node-positive disease? 1) Yes 95.2%
2) No 4.8%
9) Abstain 0% Postmenopausal patients with node-negative disease? 1) Yes 14.6%
2) No 80.5%
9) Abstain 4.9% Postmenopausal patients with grade 3 or high Ki-67? 1) Yes 76.7%
2) No 18.6%
9) Abstain 4.7% Postmenopausal patients, premenopausal at baseline? 1) Yes 66.7%
2) No 25.6%
9) Abstain 7.7% 17. Endocrine Therapy: Duration Provided
an indication exists for therapy beyond the first 5 years: After
5 years of adjuvant therapy involving switch from Tam to an AI (therefore assuming
postmenopausal status at the 5 year time point and reasonable tolerance to
endocrine therapy), patients should be recommended to receive: A further 5 years of tamoxifen 1) Yes 39.4%
2) No 57.6%
9) Abstain 3% Continue AI to a cumulative total of 5 years AI 1) Yes 75%
2) No 22.5%
9) Abstain 2.5% A further 5 years AI 1) Yes 31.4%
2) No 60% 9)
Abstain 8.6% No further endocrine therapy 1) Yes 13.9%
2) No 83.3%
9) Abstain 2.8% After 5 years of
straight AI
adjuvant therapy, patients should be recommended to receive: A further 3 to 5 years of tamoxifen 1) Yes 34.1%
2) No 63.4%
9) Abstain 2.4% A further 3 to 5 years AI 1) Yes 42.9%
2) No 57.1%
9) Abstain 0% No further endocrine therapy 1) Yes 40.9%
2) No 54.5%
9) Abstain 4.5% 中休み後 After 5 years of adjuvant therapy involving
tamoxifen x 2 years followed by AI x 3 years (assuming postmenopausal status
and tolerance of hormonal therapy), the preferred treatment is: 1)
Additional 5 years of tamoxifen 3.2% 2)
Continue AI to a total of 5
years in total 54.8% 3)
Continue AI for 5 full years 16.1% 4)
No further treatment 16.1% 9)
Abstain
9.7% After 5 years of
straight AI therapy, my recommendation in a patient who remains at moderate
risk of recurrence and is tolerating endocrine therapy is: 1)
3 – 5 years of tamoxifen 27% 2)
3 – 5 years of AI 37.8% 3)
No further endocrine therapy
29.7% 9)
Abstain
5.4% The optimal duration of OFS in a premenopausal woman who has an
indication to receive this treatment is: 1)
2 – 3 years 16.7% 2)
5 years 56.7% 3)
Lifelong 3.3% 9)
Abstain 23.3% 18. Chemotherapy Factors
which are relative
indications for the inclusion of adjuvant cytotoxic chemotherapy include: Histological grade 3 tumor 1) Yes 97.4%
2) No 2.6%
9) Abstain 0% Any positive node 1) Yes 38.7%
2) No 61.3%
9) Abstain 0% 4 or more positive node 1) Yes 95.1%
2) No 4.9%
9) Abstain 0% Ki-67 high 1) Yes 75%
2) No 8.3%
9) Abstain 16.7% Age < 35 1) Yes 41.7%
2) No 58.3%
9) Abstain 0% Extensive lymph-vascular invasion 1) Yes 67.6%
2) No 32.4%
9) Abstain 0% Low hormone receptor staining 1) Yes 81.1%
2) No 18.9%
9) Abstain 0% 19. Chemotherapy: Luminal A Is
Luminal A phenotype less responsive to chemotherapy? 1) Yes 88.1%
2) No 4.8%
9) Abstain 7.1% Should
chemotherapy be added for high risk (based on T-size)? 1) Yes 36.4%
2) No 63.6%
9) Abstain 0% If
so, the minimum T-size to recommend chemotherapy is: 1.
1 cm
2.6% 2.
2 – 5 cm
10.5% 3.
> 5 cm 23.7% 9.
Abstain (e.g. if you voted NO
to the previous question) 63.2% 20. Chemotherapy: Luminal A Should
chemotherapy be added for high risk (based on LVI)? 1) Yes 28.6%
2) No 66.7%
9) Abstain 4.8% Should
chemotherapy be added for high risk (based on 1 – 3 nodes involved)? 1) Yes 34.9%
2) No 65.1%
9) Abstain 0% Should
chemotherapy be added for high risk (based on 4 or more nodes involved)? 1) Yes 91.1%
2) No 6.7%
9) Abstain 2.2% 21. Chemotherapy: Luminal B (HER2 negative) In
IHC Luminal B-like tumors chemotherapy
should be recommended in: All patients 1) Yes 22%
2) No 78% 9)
Abstain 0% Only in patients with other indications of increased risk 1) Yes 87.5%
2) No 7.5%
9) Abstain 5% Chemotherapy may
be omitted
for patients with luminal B-like disease and: Low Oncotype DX score 1) Yes 94.9%
2) No 0% 9) Abstain 5.1% Intermediate Oncotype DX score 1) Yes 36.4%
2) No 43.2%
9) Abstain 20.5% MammaPrint Low Risk 1) Yes 72.1%
2) No 16.3%
9) Abstain 11.6% Low PAM50 ROR score 1) Yes 82.5%
2) No 7.5%
9) Abstain 10% EndoPredict Low Risk 1) Yes 69.6%
2) No 10.9%
9) Abstain 17.4% 22. Chemotherapy: Luminal B (HER2 negative) If
given, should the regimen contain anthracylines? 1)
Yes 83.3%
2) No 13.9%
9) Abstain 2.8% If given, should
the regimen contain taxanes? 1)
Yes 76.9%
2) No 20.5%
9) Abstain 2.6% Should
chemotherapy ever comprise 6 cycles of the same therapy (e.g, 6 courses of FEC
or AC)? 1)
Yes 21.6%
2) No 75.7%
9) Abstain 2.7% Is there a high
risk group for which dose-dense therapy with G-CSF should be preferred? 1)
Yes 57.1%
2) No 40% 9)
Abstain 2.9% 23. Chemotherapy: TNBC Ductal Should
the regimen for TNBC phenotype contain anthracyclines and taxanes? 1) Yes 92.3%
2) No 2.6%
9) Abstain 5.1% Should
a platinum based regimen be considered? In all patients with TNBC? 1) Yes 7.1%%
2) No 92.9%
9) Abstain 0% Only when known BRCA mutation? 1)
Yes 57.9%
2) No 36.8%
9) Abstain 5.3% In young age < 40 years with TNBC? 1) Yes 75%
2) No 25% 9)
Abstain 0% In patients < 60 years with TNBC 1) Yes 77.8%
2) No 11.1%
9) Abstain 11.1% Should
dose-dense ChT requiring growth factor support be preferred? 1) Yes 45%
2) No 52.5%
9) Abstain 2.5% 24. Chemotherapy: HER2-positive Stage 2 Should
chemotherapy always be given to patients with stage 1 disease who require
anti-HER2 therapy? 1) Yes 97%
2) No 3% 9) Abstain 0% Should
the chemotherapy regimen for these patients preferably contain anthracyclines? 1) Yes 88.9%
2) No 7.4%
9) Abstain 3.7% Should
the chemotherapy regimen for these patients contain taxanes? 1) Yes 97.2%
2) No 2.8%
9) Abstain 0% Should
anti-HER2 therapy start concurrent with taxane? 1) Yes 97.3%
2) No 2.7%
9) Abstain 0% 25. Chemotherapy:
HER2-positive Assuming
HER2 positivity is determined according to ASCO/CAP guidelines: l Do the large majority of patients with HER2 positive stage 1
disease require anti-HER2 therapy: Ø with T1a disease? 1) Yes 20.7%
2) No 79.3%
9) Abstain 0% Ø with T1b disease? 1) Yes 81.4%
2) No 18.6%
9) Abstain 0% Ø with T1c disease? 1) Yes 100%
2) No 0% 9) Abstain
0% l If given, should the chemotherapy regimen for these patients contain
anthracyclines? 1) Yes 57.9%
2) No 42.1%
9) Abstain 0% l If given, is the combination of paclitaxel and trastuzumab a
reasonable option? 1)
Yes 86.5%
2) No 2.7%
9) Abstain 10.8% l Stage 1, HER2 positive, T-size < 1cm 1)
Anthracyclines → Taxane + Trastuzumab 27% 2)
Palictaxel + Trastuzumab 64.9% 3)
Something else
8.1% 9)
Abstain 0 26. Anti-HER2 Therapy – Which Agents? (These
questions assume the availability of the relevant agents) In
patients requiring anti-HER2 therapy in the postoperative adjuvant setting for
a T2 tumor with 4 involved nodes: Therapy should include both trastuzumab and
pertuzumab 1) Yes 50%
2) No 37.5%
9) Abstain 9.4% ? 27. Neo-Adjuvant Systemic Therapy (possibly
followed by additional adjuvant chemo) Stage II
HER2-positive Disease
If given, in HER2-positive tumors, acceptable regimen should
include: Taxane + trastuzumab only 1)
Yes 18.8%
2) No 75% 9)
Abstain 6.3% 1) 7.7% 2) 23.1% 3) 12.8% 4)
0 5) Abstain 56.4% Taxane + trastuzumab only 2)
Yes 46.7%
2) No 46.7%
9) Abstain 6.7% Taxane, trastuzumab and pertuzumab 1) Yes 73.1%
2) No 19.2%
9) Abstain 7.7% Platin, taxane, trastuzumab ±pertuzumab 1)
Yes 39.3% 2)
No 53.6% 9) Abstain
3.6% Non-taxane regimen containing platin, trastuzumab±pertuzumab 1)
Yes 2.9% 2)
No 91.2% 9) Abstain
5.9% Anthracycline -> taxane and anti-HER2 1)
Yes 97.2% 2)
No 2.8% 9) Abstain
0% 28. Neo-Adjuvant Systemic Therapy Stage
II Triple-Negative Disease If given, in
patients with triple-negative tumors, the preferred regimen should include: High-dose alkylating agent 1)
Yes 17.2% 2)
No 79.3% 9) Abstain
3.4% Platin 1)
Yes 25% 2)
No 75% 9) Abstain
0% Anthracycline -> taxane 1)
Yes 94.7%
2) No 2.6%
9) Abstain 2.6% Nab-paclitaxel -> EC 1)
Yes 22.9% 2)
No 71.4% 9) Abstain
5.7% Anthracycline -> regimen with alkylating agents (e.g. classic
CMF) 1)
Yes 25.7% 2)
No 65.7% 9) Abstain 8.6% 29. Neo-Adjuvant Systemic Therapy: Chemotherapy
in Luminal Disease Neoadjuvant
cytotoxic therapy should be discussed as an option in patients with ‘Luminal
A-like’ tumors: 1.
In the majority of cases
2.9% 2.
Only if conservative surgery
would not otherwise be feasible 73.5% 3.
Never
20.6% 9.
Abstain
2.9% …and
in patients with ‘Luminal B-like’ tumors (HER2 neg.) 1.
In the majority of cases
37.8% 2.
Only if conservative surgery
would not otherwise be feasible 45.9% 3.
Only if biological features
predict high chance of pCR 16.2% 4.
Never
0 9.
Abstain
0 30. Neo-Adjuvant Endocrine Therapy Is
neoadjuvant endocrine therapy without cytotoxics a reasonable option for
postmenopausal patients with endocrine responsive disease? 1)
Yes 87.9% 2)
No 12.1% 9) Abstain
0% If
yes, for which duration? 1.
1 – 2 weeks “window” prior to
surgery 7.1% 2.
3 – 4 months
3.6% 3.
4 – 8 months
42.9% 4.
Until maximal response
42.9% 9.
Abstain
3.6% Is
neoadjuvant endocrine therapy without cytotoxics a reasonable option for
postmenopausal patients with endocrine responsive disease? 1.
In the majority of cases
2.9% 2.
Only if conservative surgery
would not otherwise be feasible 73.5% 3.
Never
20.6% 9.
Abstain
2.9% 31. Neo-Adjuvant Systemic Therapy Chemotherapy
in Luminal Disease Neoadjuvant
cytotoxic therapy should be discussed as an option in patients with ‘Luminal
A-like’ tumors: …and in patients with ‘Luminal B-like’ tumors (HER2 neg.) 1)
Yes
16% 2) No
60% 9) Abstain
4% 1.
In the majority of cases
37.8% 2.
Only if conservative surgery
would not otherwise be feasible 45.9% 3.
Only if biological features
predict high chance of pCR
16.2% 4.
Never
0 9.
Abstain
0 Neoadjuvant
cytotoxic therapy should be discussed as an option in patients with ‘Luminal
A-like’ tumors: 1.
In the majority of cases
5.1% 2.
Only if conservative surgery
would not otherwise be feasible 71.8% 3.
Never
23.1% 9.
Abstain
0 32. Bisphosphonates Is
bisphosphonate treatment, such as zoledronic acid q 6 months or oral
clodronate, during adjuvant endocrine therapy indicated to improve DFS? In premenopausal patients receiving LHRH plus TAM? 1) Yes 43.6%
2) No 56.4%
9) Abstain 0% In premenopausal patients not receiving LHRH? 1)
Yes 5.3% 2)
No 94.7% 9) Abstain
0% In postmenopausal patients? 1)
Yes 58.3% 2)
No 41.7% 9) Abstain
0% Should adjuvant
denosumab substitute for bisphosphonate? 1)
Yes 3.7% 2)
No 88.9% 9) Abstain
7.4% 33. Elderly Patients In the
absence of significant co-morbidity the maximum age at which a standard chemotherapy
regimen should be advised is: 1.
55 yrs 2.6% 2.
65 yrs 0 3.
70 yrs 2.6% 4.
75 yrs 0 5.
80 yrs 7.7% 6.
There is no absolute age limit.
Rather, it depends on the disease, the presence of co-morbidity, the life
expectancy, and the patient’s preferences 87.2% 9.
Abstain 0 34. Elderly Patients: Radiation In
postmenopausal patients with ER-positive tumors receiving endocrine therapy,
radiation after breast conserving surgery can be omitted
in patients aged over: 1.
55 yrs 0% 2.
65 yrs 5.6% 3.
70 yrs 27.8% 4.
75 yrs 8.3% 5.
80 yrs 0 6.
There is no age at which
radiation should be omitted 55.6% 10. Abstain
2.8% 35. Young Patients (Age < 40) Testing for BRCA 1 and 2 mutations is indicated 1)
Yes 73.5%
2) No 23.5%
9) Abstain 0% Testing
for BRCA 1 and 2 mutations is indicated for TNBC (?) 1)
Yes 90.9% 2)
No 6.1% 9) Abstain
3% (?) 1)
7.7% 2) 23.1% 3) 12.8%
4) 0 5) 56.4% (?) 1)
48.5% 2) 48.5%
9) 3% Testing for high risk mutations in other genes (e.g. PALB2) is
indicated 1)
Yes 41.2% 2)
No 50% 9) Abstain
8.8% Fertility preservation (e.g. by ovarian tissue or oocyte
conservation) should be offered 1)
Yes 87.5% 2)
No 10% 9) Abstain
2.5% Ovarian function suppression during chemotherapy for
receptor-negative disease should be offered 1)
Yes 78.9% 2)
No 18.4% 9) Abstain
2.6% 36. High Risk Mutations
Testing for high risk mutations is indicated in: All women with breast cancer 1) Yes 11.1%
2) No 88.9%
9) Abstain 0% Patients with a strong family history 1)
Yes 94.3% 2)
No 5.7% 9) Abstain
0% Patients under 35 at diagnosis 1) Yes 88.9%
2) No 7.4%
9) Abstain 3.7% Patients under 50 at diagnosis 1) Yes 7.4%
2) No 92.6%
9) Abstain 0% Patients under 50 with ER and HER negative tumors 1) Yes 70%
2) No 30% 9)
Abstain 0% Patients with ER and HER2 negative tumors 1) Yes 25.7%
2) No 71.4%
9) Abstain 2.9% Patients with a basal-like tumor 1) Yes 48.6%
2) No 45.7%
9) Abstain 5.7% Discovery of a
BRCA 1 or 2 mutation influences treatment of the tumor 1)
Yes 77.8%
2) No 22.2%
9) Abstain 0% Discovery of a BRCA 1 or 2 mutation influences treatment of the
tumor (adjuvant) 1) Yes 28.9% 2)
No 65.8% 9) Abstain
5.3% 37. Breast Cancer Diagnosed During
Pregnancy l Premature delivery should be avoided if possible 1) Yes 88.9%
2) No 3.7%
9) Abstain 7.4% l Breast conservation is a suitable option 1) Yes 89.5%
2) No 2.6%
9) Abstain 7.9% l Lymphoscintigraphy and SNB are safe 1) Yes 64.5%
2) No 29% 9)
Abstain 6.5% l Immediate post-mastectomy reconstruction is an appropriate option 1) Yes 52.6%
2) No 36.8%
9) Abstain 10.5% l If indicated, anti-HER2 therapy should be delayed until after
delivery 1) Yes 87.2%
2) No 7.7%
9) Abstain 5.1% 38. Pregnancy After Breast Cancer
Is it reasonable to interrupt endocrine therapy to allow attempted pregnancy: l At any time during endocrine therapy? 1) Yes 26.3%
2) No 68.4%
9) Abstain 5.3% l After 18 – 30 months endocrine therapy? 1) Yes 60.6%
2) No 30.3%
9) Abstain 9.1% l Only in absence of high risk factors? 1)
Yes 61.1%
2) No 27.8%
9) Abstain 11.1% Post-manopausal, T2, ER positive, HER2
negative tumor? 1) endocrine therapy 83.8%
2) chemotherapy 16.2%
9) Abstain 0% 39. Male Breast Cancer Most breast cancers in males are endocrine
responsive. Tamoxifen is currently advised. Adjuvant therapy options beyond
tamoxifen include: l Aromatase inhibitors alone 1) Yes 29%
2) No 58.1%
9) Abstain 12.9% l Aromatase inhibitors + LHRN a 1) Yes 29.6%
2) No 66.7%
9) Abstain 3.7% l Complete estrogen blockade AR? 40. Diet and Exercise l Should patients receive specific dietary advice? 1) Yes 40%
2) No 57.5%
9) Abstain 2.5% l Should patients with vitamin D deficiency receive vitamin D
supplement? 1) Yes 57.1%
2) No 34.3%
9) Abstain 8.6% l Should an exercise regimen be part of standard care? 1) Yes 76.7%
2) No 23.3%
9) Abstain 0% l Should weight loss / avoidance of weight gain be recommended? 1) Yes 87.5% 2) No 7.5% 9) Abstain
5% |
