Chapter 4: Bringing mTNBC Guidelines to the Bedside

Return to the series here.

Katie Newlin: Hi, everyone. My name is Katie Newlin. I'm a nurse practitioner at Washington University in St. Louis, and I'm here today with some of my colleagues, and we are talking about metastatic triple-negative breast cancer and where we are today in the scheme of things.

Sanita Burgic: Good morning. My name is Sanita Burgic, and I'm a nurse practitioner at Washington University in St. Louis as well.

Ashley Martinez: Hi. I'm Ashley Martinez. I'm also a nurse practitioner at UTMD Anderson Cancer Center.

Amanda Brink: I'm Amanda Brink. I'm a nurse practitioner in Sarah Cannon Research Institute's Drug Development Unit in Denver. In this last section, we're going to talk about bringing guidelines to the bedside. I'm Amanda Brink. I'm a nurse practitioner at the drug development unit at the Sara Cannon Research Institute in Denver.

All of this data we've been discussing is compelling, but translating it into the community or a rural clinic can feel like a different challenge entirely. Let's talk about what it looks like to implement these guidelines into practice, and we're going to start with just a short case.

A 52-year-old woman presents to your community oncology clinic with newly diagnosed de novo metastatic TNBC. Her ECOG performance status is one. She's the primary caregiver for two children and works part-time. PD-L1 testing is pending, and you expect it to return in about five to seven days. Sanita, when you're starting a patient on a frontline regimen, how do you think about what comes next? Do you discuss it with the patient upfront?

Sanita Burgic: Yeah. In practice, many clinicians now approaches as a sequencing conversation rather than a single treatment regimen. While frontline therapy prioritizes depth and durability of treatment, the APPs increasingly framed the discussion around the idea that multiple active treatments are available, that they exist, and that maintaining eligibility for subsequent lines of therapy is part of this overall strategy. Some clinicians would discuss these options upfront in terms of the triple-negative breast cancer treatments, but I feel that the key balance is acknowledging that the best first option matters, while also reinforcing that the treatment is not a one-time decision, and that we would maybe adjust the treatments as new response tolerability information becomes available to us.

Katie Newlin: Patients in rural settings may face additional logistical challenges, including travel burden, limited availability of infusion chairs, and reduced access to specialists. APPs in this setting do really... They serve as the primary coordinator for these patients, managing the infusion schedules, insurance navigation, and patient education. I think that's important to note as well.

Sanita Burgic: I agree to stay in close contact with our social work team and provide them with all the resources we have available to keep patients on track.

Ashley Martinez: Yeah. I completely agree. Sometimes it can look different in a community-based setting than in an academic setting, but I think that if we streamline and avoid potential delays in the community setting, it is very beneficial for our patients.

Katie Newlin: All right. Before we wrap up, what's the single most important thing that you think the listeners who are listening today, what's one of the most important things that they should take away from this message?

Ashley Martinez: Thanks, Katie. I think for APPs, they should really stay up to date with guidelines, groundbreaking clinical trials, and adverse events, and really kind of develop like an accountability partner. If there's somebody else in your practice that you can keep accountable to stay up to date with these types of guidelines, I think it's very beneficial, not only for us as APPs, but then we can translate that over to our patients and educate them.

Amanda Brink: To piggyback off that, I think the most important message for me is for APPs to just embrace being lifelong learners. The treatment landscape is always changing, and you're not going to know everything, every guideline, the moment it comes out, and that's okay. Just embrace curiosity and staying up to date.

Sanita Burgic: I agree. I feel like, with these treatments, they are successful and active, but just as successful as the treatments are, how we, as APPs, support our patients in being proactive, and the education we provide is just as important. Just giving ourselves some credit for that as well.

Katie Newlin: Thank you again for joining us today and learning a little bit more about the frontline ADC-based regimens and metastatic triple-negative breast cancer. Thanks so much.