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Living with cancer· Appointment prep

Appointment sheet: HR-positive / HER2-negative breast cancer

One page to bring and write on: your details, the questions for HR-positive / HER2-negative breast cancer plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

HR-positive / HER2-negative breast cancer

Prepared with OnCo (onco.cc/prep/breast-hr-positive/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

47 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example ER/PR, HER2 IHC 0/1+/2+, Ki-67, Oncotype DX / MammaPrint / Prosigna, PIK3CA/AKT1/PTEN), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Early stage
  1. 5.For my situation (early stage), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Oncotype DX, Abemaciclib, Ribociclib, and what side effects should I expect?
  3. 7.How do the results of monarchE and NATALEE apply to someone like me?
Metastatic first line
  1. 8.For my situation (metastatic first line), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Palbociclib, Ribociclib, Abemaciclib, and what side effects should I expect?
Metastatic second line
  1. 10.For my situation (metastatic second line), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Capivasertib, Inavolisib, Elacestrant or related drugs, and what side effects should I expect?
Endocrine-resistant
  1. 12.For my situation (endocrine-resistant), which of the standard options do you recommend and why?
  2. 13.Am I a candidate for Trastuzumab deruxtecan, Sacituzumab govitecan, Datopotamab deruxtecan, and what side effects should I expect?
  3. 14.How do the results of DESTINY-Breast06 apply to someone like me?
Screening and diagnosis
  1. 15.For my situation (screening and diagnosis), which of the standard options do you recommend and why?
Early stage, deciding on chemotherapy
  1. 16.For my situation (early stage, deciding on chemotherapy), which of the standard options do you recommend and why?
  2. 17.Am I a candidate for Oncotype DX, MammaPrint (70-gene signature), and what side effects should I expect?
  3. 18.How do the results of TAILORx and RxPONDER (SWOG S1007) apply to someone like me?
Early stage, adjuvant endocrine therapy
  1. 19.For my situation (early stage, adjuvant endocrine therapy), which of the standard options do you recommend and why?
  2. 20.Am I a candidate for Letrozole (and other aromatase inhibitors), Tamoxifen, Goserelin / leuprolide (ovarian function suppression), and what side effects should I expect?
  3. 21.How do the results of SOFT & TEXT apply to someone like me?
Early stage, high risk: adjuvant CDK4/6
  1. 22.For my situation (early stage, high risk: adjuvant cdk4/6), which of the standard options do you recommend and why?
  2. 23.Am I a candidate for Abemaciclib, Ribociclib, Olaparib, and what side effects should I expect?
  3. 24.How do the results of monarchE and NATALEE apply to someone like me?
Early stage, extended and adjuvant SERD (emerging)
  1. 25.For my situation (early stage, extended and adjuvant serd (emerging)), which of the standard options do you recommend and why?
  2. 26.Am I a candidate for Giredestrant, and what side effects should I expect?
  3. 27.How do the results of lidERA and CAMBRIA-1 & CAMBRIA-2 apply to someone like me?
Metastatic, first line
  1. 28.For my situation (metastatic, first line), which of the standard options do you recommend and why?
  2. 29.Am I a candidate for Ribociclib, Abemaciclib, Palbociclib or related drugs, and what side effects should I expect?
  3. 30.How do the results of MONALEESA-2 and MONARCH 3 apply to someone like me?
Metastatic, molecular progression on first line
  1. 31.For my situation (metastatic, molecular progression on first line), which of the standard options do you recommend and why?
  2. 32.Am I a candidate for Camizestrant, and what side effects should I expect?
  3. 33.How do the results of SERENA-6 apply to someone like me?
Metastatic, second line by genotype
  1. 34.For my situation (metastatic, second line by genotype), which of the standard options do you recommend and why?
  2. 35.Am I a candidate for Gedatolisib, Elacestrant, Imlunestrant or related drugs, and what side effects should I expect?
  3. 36.How do the results of EMBER-3 and EMERALD apply to someone like me?
Metastatic, endocrine-resistant: ADC before chemotherapy
  1. 37.For my situation (metastatic, endocrine-resistant: adc before chemotherapy), which of the standard options do you recommend and why?
  2. 38.Am I a candidate for Trastuzumab deruxtecan, Sacituzumab govitecan, Datopotamab deruxtecan, and what side effects should I expect?
  3. 39.How do the results of DESTINY-Breast06 and DESTINY-Breast04 apply to someone like me?
Metastatic, chemotherapy and later lines
  1. 40.For my situation (metastatic, chemotherapy and later lines), which of the standard options do you recommend and why?
  2. 41.Am I a candidate for Paclitaxel / nab-paclitaxel, Olaparib, Talazoparib, and what side effects should I expect?
Bone-predominant disease and survivorship
  1. 42.For my situation (bone-predominant disease and survivorship), which of the standard options do you recommend and why?
Any stage
  1. 43.Are there clinical trials I could join, for example of Vepdegestrant, Sacituzumab tirumotecan, Datopotamab deruxtecan, ArteraAI Breast?
  2. 44.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 45.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 46.I read that “Late recurrence (up to 20+ years) with no predictive test”. How does that affect my plan?
  5. 47.I read that “CDK4/6 resistance mechanisms and sequencing”. How does that affect my plan?

The words I may hear

  • ESR1 mutation: A change in the oestrogen receptor gene that lets the cancer grow without oestrogen, so aromatase inhibitors stop working.
  • Aromatase inhibitor: Pills that stop the body making oestrogen (after the menopause, when it comes from fat and muscle rather than the ovaries), starving hormone receptor-positive breast cancer.
  • Selective oestrogen receptor degrader (SERD): Drugs that do not just block the oestrogen receptor but mark it for destruction, so the cancer cell loses the receptor altogether.
  • Endocrine resistance: When hormone therapy stops controlling a hormone-driven breast cancer, either quickly (primary) or after years (acquired).
  • Oral SERD: An oral SERD is a pill that destroys the oestrogen receptor rather than just blocking it, replacing the monthly fulvestrant injection.
  • Ovarian function suppression (OFS): Temporarily switching off the ovaries with injections (or removing them) so a premenopausal woman's cancer is starved of oestrogen.
  • HER2-low and HER2-ultralow: Tumours with a little HER2 (IHC 1+ or 2+ without amplification), or a trace (ultralow), which older HER2 drugs ignored but Enhertu can attack.
  • Hormone therapy: Treatment that starves cancers which grow in response to a hormone, mainly oestrogen in breast cancer and testosterone in prostate cancer, by lowering the hormone or blocking its receptor.
  • Late recurrence: Hormone-driven breast cancer can come back 10 or even 20 years after treatment, unlike most cancers, which is why hormone therapy lasts so long.
  • Ductal carcinoma in situ (DCIS): Breast cancer cells confined inside the milk ducts, found mostly by mammography as calcifications.

Tests and results to bring

Screening and diagnosis: Mammography ± tomosynthesis; supplemental MRI for dense breasts or high risk; core biopsy with ER/PR/HER2/Ki-67; AI-assisted reading being deployed.

Biomarker results to ask for: ER/PR, HER2 IHC 0/1+/2+ (low, ultralow), Ki-67, Oncotype DX / MammaPrint / Prosigna, PIK3CA/AKT1/PTEN, ESR1 (ctDNA), gBRCA, ER and PR by IHC (≥1%; 1-10% 'ER-low' behaves like TNBC), HER2 IHC 0/1+/2+ with the low and ultralow categories for T-DXd eligibility, Ki-67 (≥20% defines high risk for adjuvant abemaciclib, monarchE cohort 2), Oncotype DX recurrence score, MammaPrint, Prosigna, Breast Cancer Index (late recurrence, extended ET), PIK3CA, AKT1, PTEN alterations (tissue or ctDNA) for PI3K/AKT-pathway drugs, ESR1 mutation by ctDNA (serial monitoring endorsed by SERENA-6), gBRCA1/2 (olaparib, OlympiA), Menopausal status and oestradiol (for AI eligibility, OFS adequacy), Bone density (AI-induced loss), CDK4/6 resistance markers under study: RB1 loss, CCNE1, FGFR1 amplification.

Scans and tests linked to this cancer: Companion diagnostics, Comprehensive genomic profiling, Cytogenetics and FISH, Germline (hereditary) testing, Histopathology & immunohistochemistry, HRD & BRCA testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call