@BianchiniGP @CarmenCriscit @Annals_Oncology @OncoAlert instead of calling them TNBC, I propose we call these tumors by their underlying biology rather than by 2 features (HER2+ER), which are not even standardized.This will require more expensive tests than IHC, but do we want precision oncology for diagnostics? or only for drugs?

@prat_aleix @CarmenCriscit @Annals_Oncology @OncoAlert I agree Aleix. We want to be as much precise as possible. The messages are that carful clinical judgment should guide treatment decision for “ER Low”, most behavior like TN, more data is needed, and diagnostics such as intrinsic might help (and should be interpreted in contest)

@BianchiniGP @oncologician @Annals_Oncology @OncoAlert Also remember that recent in vivo work showed that estrogen levels in brain increased TNBC mets to the brain. Worth considering? I think so.

@nursekristinrn @oncologician @Annals_Oncology @OncoAlert Yes, thank you for pointing it out

@BianchiniGP @Annals_Oncology @OncoAlert The great question for me is should they be offered anti hormonal treatments of any kind? Does the research provide information?

@BianchiniGP @Annals_Oncology @OncoAlert 3 subtypes in HR+/HER2-. 1. strong ER+/PR+; 2. strong ER+/PR-; 3. weak ER+. Q is should recommendations (eg st gallen) be tailored so that group 3 gets chemo at an earlier stage and in pre-menopausal group 2 gets OFS+AI at an earlier stage. Does current guidance undertreat these?