Around the Practice: Updates in HER2+ Breast Cancer - Episode 5

Screening and Monitoring Visceral Disease in HER2+ BC

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Claudine Isaacs, MD, comments on the follow-up and monitoring for a patient similar to the case presentation with HER2+ breast cancer.

Vijayakrishna Gadi, MD, PhD: We’re going to do 1 quick polling question. In your patients with visceral disease, how often do you screen for brain metastases? Every 3 months, every 6 months, every year? Based on symptoms? Assuming a few more answers might come in, it looks like the plurality of folks would do it based on symptoms. There are a few folks who might do it, scheduled maybe once a year, but no one for every 3 months or every 6 months. Certainly I’ve seen those in my discussions with other folks. Dr Isaacs, for the patient we just discussed—we’ll just touch on this very quickly—what follow-up and monitoring do you do for a patient, like the 1 with this visceral disease we just talked about?

Claudine Isaacs, MD: I monitor with scans. Just routinely. Whether we do PET [positron emission tomography] CTs, or CTs and bone scans, I do those about every 3 months or so. If somebody is really coasting on it, like the patients in the CLEOPATRA trial, I start to gradually extend it and take it to 4 months, then 6 months, and follow like that. I’m trying to figure out how often I want to do scans to the brain. What I’ve settled on, at least for now, is every time that I’m changing therapy and they have disease progression, I’ve started doing it. But I haven’t routinely done it in the asymptomatic patient at every scanning period. What we’re really looking for are asymptomatic small brain metastases. For most patients that means we would be sending them to an MRI every 3 months or so. I haven’t transitioned to that. I recognize that I might, as the data continue to evolve. But right now I’m doing it more at the time they develop metastatic disease, and then at the time of progression. Every so often, if we have 1 of these patients who’s coasting forever on HP [trastuzumab, pertuzumab], once a year I might throw something in just to make sure I wasn’t missing something.

Vijayakrishna Gadi, MD, PhD: That’s very sensible. And we recognize your right to change your answer.

Claudine Isaacs, MD: That’s the good news. We constantly evolve as data evolve.

Vijayakrishna Gadi, MD, PhD: That’s right.

Transcript edited for clarity.