MSCO | QNA

Thank your for your time!

Q1. What is the association of pathological complete response (PCR) and patient outcomes?

A: PCR has no impact on patient outcomes 0%

B: PCR has negative impact on patient outcomes 0%

C: PCR provided a better association with improved outcomes 0%

D: None of the above 0%

In the study “Pathological complete response in neoadjuvant treatment of breast cancer”, the Collaborative Trials in Neoadjuvant Breast Cancer group demonstrated that pCR defined as no residual invasive cancer in the breast and axillary nodes with presence or absence of in situ cancer (ypT0/is ypN0 or ypT0 ypN0) provided a better association with improved outcomes compared to eradication of invasive tumor from the breast alone (ypT0/is).

(Ann Surg Oncol, 2015 May;22(5):1441-6. doi: 10.1245/s10434-015-4404-8. Epub 2015 Mar 2)

Q2. What are the key findings of adjuvant trastuzumab emtansine (T-DM1) for residual invasive HER2-Positive Breast Cancer?

A: 3-year IDFS rate improved from 77.0% to 88.3% 0%

B: The benefit of T-DM1 was consistent across all subgroups including hormone receptor status, extent of residual invasive disease and single or dual HER2-targeted neoadjuvant therapy 0%

C: The unstratified hazard ratio is 0.5. 0%

D: All of the above 0%

In the study “Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer”, the estimated percentages of patients who would be free of invasive disease at 3 years were 88.3% in the T-DM1 group and 77.0% in the trastuzumab group .Invasive disease–free survival, the primary end point, was significantly higher among patients who received T-DM1 than among those who received trastuzumab (hazard ratio, 0.50; 95% confidence interval [CI], 0.39 to 0.64; P<0.001). A subgroup analysis of invasive disease–free survival revealed a consistent benefit of T-DM1 across stratification cohorts and other subgroups (Figure 2), including patients with hormone-receptor–positive or hormone-receptor–negative disease, patients with positive or negative pathological nodal status after neoadjuvant therapy, and patients with either no residual invasive primary disease or residual primary disease of 1 cm or less in the breast.

(N Engl J Med 2019; 380:617-628)

Q3. What type of HER2 positive breast cancer patient should receive neoadjuvant chemotherapy (NAC)?

A: Tumor >2cm and/or node positive 0%

B: Tumor >2cm and/or node negative 0%

C: Tumour ≤2 cm 0%

D: All HER2 positive breast cancer patients should receive NAC 0%

Current, ESMO guidelines recommend a neoadjuvant approach should be preferred in subtypes

highly sensitive to chemotherapy, such as triple-negative and HER2-positive, in tumours >2 cm [II, A] and/or a positive axilla.

Q4. Which imaging modalities should be used to monitor response after completion of neoadjuvant therapy?

A: Mammogram and MRI 0%

B: Mammogram and ultrasound 0%

C: Mammogram, breast and axillary ultrasound, and MRI 0%

D: Breast and axillary ultrasound and MRI 0%

Current, ESMO guidelines recommend breast mammogram, ultrasound of the breast and lymph nodes, and MRI for all patients prior to and following neoadjuvant systemic therapy to assess disease involvement and evaluate response to therapy

Q5. What would be the benefits of neoadjuvant chemotherapy?

A: Shrink tumor and allow a chance for breast conservation 0%

B: Monitor response of tumor to chemotherapy and determine patient’s prognosis 0%

C: Allow further treatment if residual disease 0%

D: All of the above 0%

Referring to speaker slide: at time 44:00