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Living with cancer· Appointment prep

Appointment sheet: HR-positive metastatic breast cancer after CDK4/6 inhibitors

One page to bring and write on: your details, the questions for HR-positive metastatic breast cancer after CDK4/6 inhibitors 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 metastatic breast cancer after CDK4/6 inhibitors

Prepared with OnCo (onco.cc/prep/hr-positive-metastatic-post-cdk46/). 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

24 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 ESR1 mutation on circulating tumour DNA, retested at each progression, PIK3CA, AKT1 and PTEN alterations on tissue or plasma, HER2 immunohistochemistry score, Oestrogen receptor persistence on rebiopsy of a metastasis, Germline BRCA1 and BRCA2), 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?
ESR1-mutant disease after a CDK4/6 inhibitor
  1. 5.For my situation (esr1-mutant disease after a cdk4/6 inhibitor), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Elacestrant, Imlunestrant, Camizestrant or related drugs, and what side effects should I expect?
  3. 7.How do the results of EMERALD and EMBER-3 apply to someone like me?
PIK3CA, AKT1 or PTEN alteration
  1. 8.For my situation (pik3ca, akt1 or pten alteration), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Capivasertib, Alpelisib, Inavolisib or related drugs, and what side effects should I expect?
  3. 10.How do the results of CAPItello-291 and SOLAR-1 apply to someone like me?
No targetable alteration
  1. 11.For my situation (no targetable alteration), which of the standard options do you recommend and why?
  2. 12.Am I a candidate for Abemaciclib, Everolimus, Exemestane, and what side effects should I expect?
  3. 13.How do the results of postMONARCH and evERA apply to someone like me?
Endocrine-refractory, HER2-low or ultralow
  1. 14.For my situation (endocrine-refractory, her2-low or ultralow), which of the standard options do you recommend and why?
  2. 15.Am I a candidate for Trastuzumab deruxtecan, Sacituzumab govitecan, Datopotamab deruxtecan, and what side effects should I expect?
  3. 16.How do the results of DESTINY-Breast06 and TROPiCS-02 apply to someone like me?
Germline BRCA carriers
  1. 17.For my situation (germline brca carriers), which of the standard options do you recommend and why?
  2. 18.Am I a candidate for Olaparib, Talazoparib, and what side effects should I expect?
  3. 19.How do the results of OlympiAD and EMBRACA apply to someone like me?
Any stage
  1. 20.Are there clinical trials I could join, for example of Vepdegestrant, Gedatolisib, Giredestrant, Camizestrant?
  2. 21.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 22.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 23.I read that “No trial has compared the sequence of oral SERD, pathway inhibitor and antibody-drug conjugate”. How does that affect my plan?
  5. 24.I read that “Whether to continue a CDK4/6 inhibitor after progression gives small gains and it is unclear for whom”. How does that affect my plan?

The words I may hear

  • 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.
  • Germline BRCA mutation (gBRCA): An inherited fault in the BRCA1 or BRCA2 gene, present in every cell from birth, that greatly raises the risk of breast, ovarian, prostate and pancreatic cancer and makes those cancers sensitive to PARP inhibitors and platinum.

Tests and results to bring

Biomarker results to ask for: ESR1 mutation on circulating tumour DNA, retested at each progression, PIK3CA, AKT1 and PTEN alterations on tissue or plasma, HER2 immunohistochemistry score (0, ultralow, 1+, 2+), Oestrogen receptor persistence on rebiopsy of a metastasis, Germline BRCA1 and BRCA2 (PARP inhibitor eligibility), Glycated haemoglobin and glucose before PI3K or AKT inhibitors.

Scans and tests linked to this cancer: Liquid biopsy (ctDNA).

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