2) Our second #tweetorial again comes from #SABCS21, which just wrapped up this month –only the most current updates for OUR followers! Our expert author is Erika Hamilton (@ErikaHamilton9) from @SarahCannonDocs in Nashville, TN and the topic is HR+ early breast cancer (#EBC). pic.twitter.com/Ie6NxHnQdp
— @onc_ce (@onc_ce) December 20, 2021
4) @SABCSSanAntonio is a primary international scientific symposium for interaction and exchange among basic scientists and clinicians working in #breastcancer. #SABCS21 was a hybrid meeting this year, with many renowned researchers welcoming the opportunity to collaborate FTF!
— @onc_ce (@onc_ce) December 20, 2021
6) So the answer is D: all BUT neoadjuvant+chemotherapy are approved for CDK4/6 treatment. That aligns with three big themes in hormone receptor positive (HR+) early breast cancer (#EBC) from #SABCS21 that we’ll discuss in this tweetorial:
— @onc_ce (@onc_ce) December 20, 2021
8) For (I) – we saw updates from #PALLAS from @MichaelGnant. This study looked at endocrine therapy (#ET) +/- palbociclib (a CDK4/6 inhibitor). We have previously seen negative data. Despite being high risk, patients who received palbociclib did NO BETTER than those who didn’t. pic.twitter.com/fgJNF52NcN
— @onc_ce (@onc_ce) December 20, 2021
10) @MichaelGnant proposes it may be continuous dosing and this may be more important in #EBC for dormant cells than in #MBC. Regardless, this leaves #abemaciclib as our FDA approved #CDK46 in combo w/ #ET for clinical high risk (N>4 or N 1-3 and T>5, G3…AND Ki-67>20% per label.
— @onc_ce (@onc_ce) December 20, 2021
12) So on to (II) – for #premenopausal patients, large meta-analysis including #TEXT #SOFT to settle the debate about endocrine therapy for youngest pts. In > 7000 pts, recurrence rates were 17.5% with tamoxifen and dropped to 14.7% with adjuvant AI (21% ⬇️).
— @onc_ce (@onc_ce) December 20, 2021
13b) pic.twitter.com/cxgDPhdgUV
— @onc_ce (@onc_ce) December 20, 2021
14b) pic.twitter.com/gwUZfDLDzX
— @onc_ce (@onc_ce) December 20, 2021
16) BUT….not everyone is high enough to need it. AND…not everyone will tolerate. #PersonalizedMedicine #SharedDecisionMaking
— @onc_ce (@onc_ce) December 20, 2021
17b)
— @onc_ce (@onc_ce) December 20, 2021
(continued)
c) You should use OFS or AI, but there is no benefit of using both at the same time.
d) Ovarian function suppression improves overall survival by a little over 3%.
19) Welcome back to our #accredited #tweetorial on highlights of HR+ #breastcancer, CDK4/6 inhibitors, chemotherapy, & personalized medicine from #SABCS21. I am @ErikaHamilton9 and you have found your new, ONLY source for oncology CE/#CME by tweetorial! Thanks for joining!
— @onc_ce (@onc_ce) December 21, 2021
21) Answer b was also correct. We saw a 1.2% higher risk of fractures w/ AI. And d was also correct, with a 3% OS benefit with OFS that in high clinical risk (<35 and receipt of chemo) increased to up to 10%!
— @onc_ce (@onc_ce) December 21, 2021
23) Takeaways:
— @onc_ce (@onc_ce) December 21, 2021
*postmeno pts w/1-3 +LN & score 0-25 DO NOT need chemo
*premeno pts DO w/scores 0-25: 5yr (invasive disease free survival) IDFS benefit 4.9% & distance recurrence free survival (DRFS) benefit 2.5%
BIG DEAL–spare chemo in ♀️ who get no add'l benefit from it pic.twitter.com/67P37cAQDY
23) Takeaways:
— @onc_ce (@onc_ce) December 21, 2021
*postmeno pts w/1-3 +LN & score 0-25 DO NOT need chemo
*premeno pts DO w/scores 0-25: 5yr (invasive disease free survival) IDFS benefit 4.9% & distance recurrence free survival (DRFS) benefit 2.5%
BIG DEAL–spare chemo in ♀️ who get no add'l benefit from it pic.twitter.com/67P37cAQDY
27) Taking the con position, Loibl talked about the risk of undertreatment, urging awareness of the problems with OVERtreatment, producing a different set of unnecessary harms. pic.twitter.com/kUBhyLiF4R
— @onc_ce (@onc_ce) December 21, 2021
29) So what do I @ErikaHamilton9 really do? Someone with lower risk factors – age in 40’s, tumor size around 2 cm, only 1 node positive. Hard to say she will likely get a real benefit from chemo – I think OS + AI may be enough.
— @onc_ce (@onc_ce) December 21, 2021
31) But remember as with all decisions and especially those with a few percentage points here and there (OS, endocrine therapy choices, chemotherapy), this is up to the individual patient and their values and expectations.
— @onc_ce (@onc_ce) December 21, 2021
33) AT #SABCS21 we finally saw the results of the adjuvant #metformin study. Yep, metformin is a drug for #diabetes but for a # of reasons we though it may lower #EBC recurrence risk. Unfortunately, the study was negative. Good for diabetes, but doesn’t help breast cancer. pic.twitter.com/mIBQO5tWJH
— @onc_ce (@onc_ce) December 21, 2021
35) Nod to @AndreaBarrio7 from @sloan_kettering: Do you know what the BIGGEST risk factor was for lymphedema? Being Black. That’s right, for women who were Black the hazard ratio (HR) for developing lymphedema was over 3.5.
— @onc_ce (@onc_ce) December 21, 2021
37) And that's it! Now go and claim your FREE CE/#CME at https://t.co/nb5Ug3FZ0b and FOLLOW US for more #accredited #tweetorials for #physicians #pharmacists #nurses. Tip o' the hat to @SABCSSanAntonio for a GREAT 2021 show!
— @onc_ce (@onc_ce) December 21, 2021