BRCA+   

Would you still treat with neoadjuvant KEYNOTE-522? 

Given OlympiA trial with olaparib benefit for gBRCA+ patients?What are barriers that you foresee? In your practice who performs mutation testing and w...

If a patient had a CPS-EG of 2 after neoadjuvant therapy, would you offer that patient olaparib even though she wouldn't have met entry criteria? If t...

If a patient has already received ADT+ARSI would you use PARPi over chemotherapy in 2nd line?

Should these patients have a different threshold for utilizing a CDK4/6 inhibitor in the front line metastatic or as part of adjuvant therapy, or SERD...

Does your approach change depending on the patients initial somatic BRCA status?

Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...

Does your approach differ across the HER2 IHC spectrum?

Assuming chemotherapy is indicated because of the Oncotype score. 

Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...

Do you perceive a difference between somatic vs germline BRCA mutations? 

Would you ever consider using these in sequence?

OlympiA trial did not include her2+ breast cancer. 

The OncotypeDx score was 51 in this scenario. 

Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.

Ref: Geyer et al, Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and hi...

In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...

Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence? 

This situation can feel uncomfortable.  Would this feel safer if patient is s/p mastectomy and had TNBC?

Do any studies support this rationale? Does the presence of a somatic vs germline BRCA mutation impact your decision?

Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses? 

How do the 5 year results of SOLO-1 at ESMO 2020 impact your recommendations?

Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?