Armando Orlandi, Medical Director at the Agostino Gemelli University Hospital Foundation IRCCS, shared a post on LinkedIn:
“SABCS 2025 Monday After
10 Things You Can Implement in Clinic Now
Great data is meaningless if we don’t apply it. Here are 10 practical changes from San Antonio that require no new drugs and no new tests — just better decisions with what you already have:
- TILs on Every Report — This is your mission: ensure pathologists report TILs as routinely as HER2. CompassHER2 + APHINITY confirm: TILs predict pCR to THP and pertuzumab benefit. It’s free, it’s on the H&E.
- SLNB Omission in Selected Patients — BOOG 2013-08 (n=1,574): in cT1N0, ER+, grade 1-2 planned for BCT, 5y regional recurrence 1.2% vs 0.5%. Non-inferiority met. Discuss omission in appropriate candidates.
- Smart Pill Bottles for Adherence — RCT with 285 patients: smart bottles achieved 69.5% adherence vs 53.1% SOC (OR 1.97). Consider recommending to patients struggling with ET adherence.
- CDK4/6i as an Option in Visceral Crisis — AMBRE trial (n=180): Abema + ET achieved 13.9 mo PFS vs 7.0 mo with chemo (HR 0.67, p=0.035). 77% had liver mets. Don’t automatically rush to chemotherapy.
- Omit IMN Boost in Imaging Complete Responders — 208 patients with baseline IMN involvement: icCR → no benefit from boost; non-icCR → 70% risk reduction (HR 0.30). Evaluate IMN response post-NAT.
- MHT is Safe in BRCA Carriers After RRM — Prospective matched analysis (676 pairs): MHT users 12.9% BC vs non-users 18.9% (p=0.002). Estrogen-only: HR 0.37 (protective). Counsel patients accordingly.
- Oncofertility Counseling is Safe — PREFER study (n=746): oocyte cryopreservation showed no detrimental effect on DFS (HR 0.78) or OS (HR 0.53). Discuss fertility preservation at diagnosis for every young patient.
- BCS After NET is Highly Achievable — ALTERNATE trial (n=933): 69.9% achieved BCS; 43.8% “ineligible” pre-NET achieved BCS. Consider NET for downstaging — don’t assume mastectomy is inevitable.
- Reconsider Routine Preop MRI — Alliance A011104 (n=319): no difference in LRC, distant recurrence, or OS between MRI and no-MRI arms. BCS rates identical at 92%. In the era of effective systemic therapy, routine MRI may be unnecessary.
- Cruciferous Vegetables Reduce BC Risk — Recommend 5-6 servings/week: broccoli, cauliflower, cabbage, Brussels sprouts, kale. Sulforaphane has established anti-cancer properties. Add this to survivorship counseling.
Evidence-based practice improvements that can start tomorrow. No approvals needed, no budget required — just knowledge translated into action.”
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