30:30
Multidisciplinary Treatment of Breast Cancer - Tumor Board
Hee Jeong Kim, Hope S. Rugo, Isabel T. Rubio, William J. Gradishar, Ricardo Audisio
The most useful thing about a tumor board is watching experts disagree in good faith. In this session, an international panel takes two early-stage breast cancer cases and works them the way...
The most useful thing about a tumor board is watching experts disagree in good faith. In this session, an international panel takes two early-stage breast cancer cases and works them the way a real team would, out loud, with the tension left in.
Moderated by Professor William Gradishar, the panel walks a 35-year-old with BRCA1-associated triple-negative breast cancer and a 50-year-old with HER2-positive, hormone-receptor-positive breast cancer from diagnosis through surgery, systemic therapy, and the decisions in between. What comes through is how much thoughtful practice varies across the United States, Europe, and Asia, and how often the right answer is a shared decision rather than a protocol.
Key points for clinicians:
Case 1 covers nodal clipping, neoadjuvant KEYNOTE-522 chemoimmunotherapy, PARP inhibition for BRCA carriers, and de-escalation of axillary surgery after an excellent response.
Fertility preservation is treated as part of the plan, with egg or embryo harvesting and GnRH agonists during chemotherapy in a young patient.
The panel openly disagrees on prophylactic bilateral mastectomy in a BRCA1 carrier, weighing contralateral risk against the limits of the survival evidence.
Case 2 examines neoadjuvant therapy thresholds for HER2-positive disease, THP versus more intensive regimens, and where antibody-drug conjugates such as T-DXd are indicated before or after after surgery.
Regional differences in mastectomy rates and de-escalation, across the US, South Korea, and China, show how the same case is managed differently around the world.