| 7:00 PM |
Introduction, meeting overview,
patterns of care (Dr Love) |
Topic 1: What information should be offered to
patients being considered for adjuvant systemic therapy?
| 7:10 PM |
Debate 1 (discussant: Dr Ravdin): |
Agree, disagree?
Patients should be offered individualized estimates of their absolute risk for recurrence and breast cancer death with and without adjuvant systemic therapy, but they should not be encouraged to consult available websites like Adjuvant!.
Topic 2: What is the most effective adjuvant
chemotherapeutic regimen?
| 7:25 PM |
Debate 2 (discussant: Dr Hudis): |
Agree, disagree?
Multiple evidence-based nonprotocol
chemotherapeutic regimens currently exist for patients with node-positive tumors; however, dose-dense AC T given as in CALGB-9741 provides the most favorable therapeutic risk-to-benefit ratio.
Topic 3: What is the current role of aromatase
inhibitors in the adjuvant setting?
| 7:45 PM |
Debate 3 (discussants: Dr Howell,
commenting on ATAC data presented earlier that morning; Dr Carlson, commenting on NCCN guidelines and ASCO Technology Assessment): |
Agree, disagree?
For postmenopausal patients with ER-positive tumors, aromatase inhibitors are standard of care as up-front adjuvant endocrine therapy. The agent that should be utilized in this situation is anastrozole. |
 |
| 8:15 PM |
Debate 4 (discussant: Dr Buzdar,
commenting on data presented that morning from the ABCSG 8, ARNO 95 and IES trials): |
Agree, disagree?
Postmenopausal patients on adjuvant tamoxifen should be switched to an aromatase inhibitor regardless of how long they have been on tamoxifen. The agents that generally should be utilized in this situation are exemestane or anastrozole.
| 8:35 PM |
Debate 5 (discussant: Dr Burstein): |
Agree, disagree?
Postmenopausal patients who have completed five years of adjuvant tamoxifen should consider starting an aromatase inhibitor based on age, comorbidity and estimated risk for relapse and death from breast cancer. The agent that generally should be utilized in this situation is letrozole.
| 8:55 PM |
Debate 6 (discussant: Dr Davidson): |
Agree, disagree?
Adjuvant treatment with ovarian ablation or
suppression alone or combined with tamoxifen or an aromatase inhibitor are experimental options that generally should not be utilized outside a protocol setting, even in a premenopausal woman with HER2-positive breast cancer and multiple positive nodes.
Topic 4: Is there a current nonprotocol role for
neoadjuvant or adjuvant trastuzumab?
| 9:15 PM |
Debate 7 (discussant: Dr Perez,
commenting on MD Anderson neoadjuvant trial presented at ASCO): |
Agree, disagree?
Currently, neoadjuvant or adjuvant trastuzumab should not be used outside a protocol setting.
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