Invasive Lobular Carcinoma: Diagnosis, Trials and What's Changing

Invasive lobular carcinoma (ILC) behaves differently from ductal breast cancer across nearly every stage of care, from how it appears on imaging to how it responds to systemic therapy. Despite this, ILC is often managed using protocols built primarily for ductal disease.

In this panel discussion, presented across CancerNetwork®, Oncology Nursing News®, and CURE®, experts in breast surgery, radiation oncology, and medical oncology join an oncology nurse and a patient advocate to examine what makes ILC distinct and how that should inform diagnosis and treatment. Patrick I. Borgen, MD, chair of the Department of Surgery at Maimonides Medical Center, moderated the discussion. Panelists included Sunil W. Dutta, MD, assistant professor in the Department of Radiation Oncology at Emory University School of Medicine; Arya Mariam Roy, MD, physician and assistant professor of medical oncology at Stefanie Spielman Comprehensive Breast Center of The Ohio State University Comprehensive Cancer Center; Pattie Jakel, MN, RN, AOCN, advanced practice oncology nurse and co-editor in chief of Oncology Nursing News; and Laurie Petiti, BS, MBA, deputy director of the Lobular Breast Cancer Alliance.

The panel coverd E-cadherin loss and its effect on tumor detectability on mammography, the ongoing debate over MRI in surgical planning, discordance between genomic assays and clinical risk in ILC, and the case for neoadjuvant endocrine therapy supported by the phase 3 OFSET trial (NCT05879926). The discussion also addresses ILC's atypical metastatic pattern, the use of FES PET imaging, HER2-mutant ILC and the SUMMIT trial, which is a phase 2 basket trial, the potential role of PARP inhibitors, and long-standing gaps in how ILC is represented in clinical trials.