Systemic Therapy for Metastatic Disease

When you use ovarian suppression for a premenopausal patient with metastatic breast cancer, which regimen do you generally recommend?

Which first-line endocrine therapy would you generally use on progression after 4 years of adjuvant anastrozole?

What percent of your patients with metastatic breast cancer would prefer to receive a monthly injection of fulvestrant rather than a daily oral endocrine agent such as an aromatase inhibitor or tamoxifen?

One acceptable clinical option for patients with ER-positive tumors who develop progressive metastatic disease on an AI is to continue the AI and add fulvestrant.

When using fulvestrant in the metastatic setting, do you generally use a loading dose?

A 60-year-old woman was diagnosed 3 years earlier with ER-positive, PR-positive, HER2-positive breast cancer and received adjuvant AC followed by tamoxifen, which she has now received for 3 years. She did not receive adjuvant trastuzumab. She now presents with moderately symptomatic bone metastases and no other sites of disease on staging. Which therapy would you recommend to this patient?

If endocrine therapy alone or in combination was chosen above, which endocrine therapy would you recommend?

A 60-year-old asymptomatic woman presents with de novo metastatic disease to bone and liver. A breast biopsy shows an ER-positive, PR-positive, HER2-positive tumor, and a liver biopsy confirms metastatic disease. Which is your most likely initial treatment strategy?

Have you used nanoparticle or nab paclitaxel?

In your opinion, how would you compare the resolution of Grade III/IV neuropathy experienced by patients receiving nab paclitaxel versus paclitaxel?

Approximately what percent of your patients have experienced an allergic reaction when using the following taxanes for breast cancer?

Approximately how many of the patients in your practice in the last 3 years, if any, have had a significant infusion reaction when using the following taxanes?

A 53-year-old woman with metastatic breast cancer, bone-only metastases and minimal symptoms will receive one of the following therapies. Please indicate the premedications you would use for each one of these regimens:

What percent of your patients with breast cancer do you think would prefer not having to receive premedication for taxanes?

Approximately what percent of patients with metastatic breast cancer who receive taxane premedication with dexamethasone develop the following symptoms? (Mean)

If cost and reimbursement for nab paclitaxel were the same as for paclitaxel, with what percent of patients to whom you would currently recommend paclitaxel for metastatic breast cancer would you use nab paclitaxel instead?

A 60-year-old woman presents with de novo metastatic ER-negative, PR-negative, HER2-negative breast cancer. She has bone and lung metastases and is mildly symptomatic. Her health insurance will cover 100% of any therapy you prescribe. You have decided to use a taxane as part of your treatment strategy. Which taxane, if any, would you most likely recommend for this patient?

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received adjuvant AC. She now presents with moderately symptomatic bone metastases and no other sites of disease on staging. How would you compare the following agents/regimens for this particular case? Your preferred docetaxel-based regimen (Doc) versus your preferred nab paclitaxel-based regimen (Nab):

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received adjuvant AC. She now presents with moderately symptomatic bone metastases and no other sites of disease on staging. How would you compare the following agents/regimens for this particular case? Your preferred docetaxel-based regimen (Doc) versus your preferred nab paclitaxel-based regimen (Nab):

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received adjuvant AC. She now presents with moderately symptomatic bone metastases and no other sites of disease on staging. How would you compare the following agents/regimens for this particular case? Your preferred docetaxel-based regimen (Doc) versus your preferred nab paclitaxel-based regimen (Nab):

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received adjuvant AC. She now presents with moderately symptomatic bone metastases and no other sites of disease on staging. How would you compare the following agents/regimens for this particular case? Your preferred docetaxel-based regimen (Doc) versus your preferred nab paclitaxel-based regimen (Nab):

Have you used bevacizumab for metastatic breast cancer off protocol?

Have you used endocrine therapy in combination with bevacizumab?

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Capecitabine + bevacizumab

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Capecitabine + bevacizumab

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Capecitabine + paclitaxel + bevacizumab

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Capecitabine + paclitaxel + bevacizumab

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Carboplatin + paclitaxel + bevacizumab

For patients with ER-negative, PR-negative, HER2-negative tumors, the following bevacizumab therapy combinations are potentially acceptable in the first-line setting. Carboplatin + paclitaxel + bevacizumab

For a patient who presents with asymptomatic metastatic disease and no prior systemic therapy, how would you compare capecitabine to capecitabine + bevacizumab?

For a patient who presents with asymptomatic metastatic disease and no prior systemic therapy, how would you compare capecitabine to capecitabine + bevacizumab?

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received AC. She now has moderately symptomatic bone metastases and no other sites of disease on staging. Which therapy would you recommend to this patient?

A 60-year-old woman was diagnosed 3 years earlier with ER-negative, PR-negative, HER2-negative breast cancer and received AC. She now has moderately symptomatic bone metastases and no other sites of disease on staging. Which therapy would you recommend to this patient?

A 60-year-old woman received AC for an ER-negative, PR-negative, HER2-negative tumor. One year later, she is diagnosed with asymptomatic bone metastases and two small pulmonary nodules. Cost and reimbursement issues aside, which therapy is likely to provide the best therapeutic ratio?

If the patient receives capecitabine and shows a response but the disease progresses after 9 months of therapy, which therapy would then provide the best therapeutic ratio?

A 60-year-old woman received AC for an ER-negative, PR-negative, HER2-negative tumor. Three years later, she is diagnosed with very symptomatic bone metastases and multiple hepatic and pulmonary nodules. Cost and reimbursement issues aside, which therapy is likely to provide the best therapeutic ratio?

Same patient: One year later, she is diagnosed with asymptomatic bone metastases and 2 small pulmonary nodules and receives docetaxel. She shows a response, but the disease progresses after a total of 9 months of therapy. Cost and reimbursement issues aside, which therapy is likely to provide the best therapeutic ratio?

Have you used the metronomic regimen of bevacizumab, cyclophosphamide and methotrexate presented by Harold Burstein at the 2005 San Antonio meeting?

Patients with metastatic disease experiencing prolonged useful responses to bevacizumab with chemotherapy should be presented with the option of continuing bevacizumab and switching to another chemotherapy at the time of progression.

Are you familiar with the RIBBON trials 1 and 2?

Taking into consideration the safety, tolerability, cost and reimbursement of the following metastatic breast cancer treatments, how much of a benefit in progression-free survival would you require clinical trials to demonstrate for you to generally prefer that therapy? Assume that the available trial data are not mature enough to evaluate overall survival.

Taking into consideration the safety, tolerability, cost and reimbursement of the following metastatic breast cancer treatments, how much of a benefit in progression-free survival would you require clinical trials to demonstrate for you to generally prefer that therapy? Assume that the available trial data are not mature enough to evaluate overall survival.

Taking into consideration the safety, tolerability, cost and reimbursement of the following metastatic breast cancer treatments, how much of a benefit in progression-free survival would you require clinical trials to demonstrate for you to generally prefer that therapy? Assume that the available trial data are not mature enough to evaluate overall survival.