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Appointment dossier — Breast Invasive Ductal Carcinoma (IDC)

Bring this to your appointment. It summarizes what published studies report — it is not medical advice and does not say anything works. Decisions are yours and your care team’s.

Compounds studied in Breast Invasive Ductal Carcinoma (IDC)

“Positive” means a study reported a positive result — most are early lab/animal work that may not translate to people.

Guideline-backed standard of care

Breast-conserving surgery (lumpectomy) + SLNB when feasible, Mastectomy when disease extent, multicentricity, prior RT, or patient preference dictates; nipple-sparing, Immediate reconstruction planning (implant or autologous), Z0011 approach: omit ALND with 1–2 positive SLNs if lumpectomy + whole-breast RT, Targeted axillary dissection post-NAT for initially node-positive patients (retrieve clipped node + SLNs) to accurately restage and potentially de-escalate ALND, Re-excision for positive margins; for invasive cancer, ‘no ink on tumor’, Place surgical clips in the tumor bed to guide boost RT and future imaging, Whole-breast irradiation (WBI) after lumpectomy, Tumor-bed boost for higher local-recurrence risk (younger age, close margins, high grade, extensive intraductal component), Post-mastectomy radiation (PMRT) for ≥4 positive nodes, Regional nodal irradiation (RNI) to axillary/supraclavicular ± internal mammary nodes based on nodal burden, biology, and response to NAT, Deep-inspiration breath hold (DIBH) for left-sided WBI/PMRT to reduce heart dose, Stereotactic radiosurgery (SRS) for limited brain metastases, Partial-breast irradiation (PBI), HR+/HER2– early: endocrine therapy (tamoxifen or aromatase inhibitor) ± ovarian function suppression (OFS) based on menopausal status and risk, Use genomic assays to decide on adjuvant chemotherapy in HR+/HER2– node-negative and select 1–3 node-positive patients undergoing upfront surgery, High-risk, node-positive HR+/HER2–: consider adjuvant abemaciclib + endocrine therapy per eligibility criteria, Postmenopausal HR+/HER2–: consider adjuvant bisphosphonates to reduce bone recurrence and fractures, Metastatic HR+/HER2–: endocrine therapy + CDK4/6 inhibitor, HER2+ stage II–III: neoadjuvant taxane-based ± anthracycline + trastuzumab/pertuzumab, Small node-negative HER2+ (e, Metastatic HER2+: first line taxane + trastuzumab + pertuzumab; second line trastuzumab deruxtecan (T-DXd) preferred; later lines, High-risk early TNBC: neoadjuvant anthracycline/taxane ± platinum with pembrolizumab, gBRCA-mutated, high-risk HER2– (HR+ or TNBC): consider 1 year of adjuvant olaparib per criteria, Metastatic TNBC: PD-L1–positive → pembrolizumab + chemotherapy; later lines, Ovarian protection: consider GnRH agonist during chemotherapy for premenopausal patients to reduce ovarian failure risk and preserve fertility, Oligometastatic disease: discuss consolidative local therapy (SBRT, surgery) after systemic response in a multidisciplinary tumor board, AC-T (doxorubicin/cyclophosphamide → paclitaxel) (early/high-risk), TC (docetaxel/cyclophosphamide) (early), THP / TCHP (taxane ± carboplatin + trastuzumab/pertuzumab) (HER2+ neoadjuvant), Capecitabine (post-neoadjuvant TNBC residual), CDK4/6 + endocrine therapy (AI or fulvestrant), Post-CDK4/6 progression: re-profile (tumor or ctDNA), Alpelisib for PIK3CA-mutant HR+/HER2– after AI, Capivasertib + fulvestrant improves outcomes in tumors with PI3K/AKT/PTEN alterations, Everolimus + exemestane restores endocrine sensitivity in some AI-resistant HR+, Adjuvant abemaciclib for high-risk node-positive HR+/HER2– improves IDFS when added to endocrine therapy (strict eligibility), PARP inhibitors (olaparib/talazoparib) for gBRCA/PALB2: adjuvant (select high-risk HER2–) and metastatic, Later-line ADCs in HR+/HER2–: sacituzumab govitecan after endocrine + targeted therapies, HER2 sequence (metastatic): taxane + trastuzumab/pertuzumab → trastuzumab deruxtecan (T-DXd) → tucatinib + trastuzumab + capecitabine (brain-active) → other TKIs (neratinib/lapatinib) case-by-case, Residual disease after neoadjuvant HER2 therapy: switch to adjuvant T-DM1 to reduce recurrence risk, Extended adjuvant neratinib for high-risk HR+/HER2+ after trastuzumab (diarrhea prophylaxis mandatory) — center-specific use, T-DXd active in HER2-low (IHC 1+ or 2+/ISH–) metastatic after prior lines — emphasize ILD vigilance and early drug holds if symptomatic, Pembrolizumab for high-risk early TNBC (neoadjuvant + adjuvant) improves pCR/EFS, Sacituzumab govitecan, gBRCA TNBC benefits from PARP inhibitors (metastatic) and adjuvant olaparib (select early), Platinum agents, HER2+ CNS disease: tucatinib-based regimens, Oligometastatic scenarios (all subtypes): consider SBRT or surgery after systemic response in tumor board, Rare MSI-H/TMB-H/NTRK fusion.

The established options for Breast Invasive Ductal Carcinoma (IDC) — ask which apply to your case. Investigational options appear in the compounds list above.

Open recruiting trials (18)

Most-relevant first: trials that name Breast Invasive Ductal Carcinoma (IDC), then broader trials you may still qualify for. Eligibility is decided by each trial's team — bring these NCT numbers to your appointment.

Financial help to look into

For each medicine above, search manufacturer and nonprofit programs at medicineassistancetool.org.

Questions to ask your oncologist

  1. Has my tumor been tested for ER (estrogen receptor), and would the result open up targeted treatments or trials?
  2. Has my tumor been tested for PR (progesterone receptor), and would the result open up targeted treatments or trials?
  3. Has my tumor been tested for HER2 (ERBB2) amplification/overexpression, and would the result open up targeted treatments or trials?
  4. Of the open trials I found (for example NCT06889688), am I eligible for any — here or at a larger cancer center?
  5. Which subtype do I have (luminal A/B, HER2+, TNBC) and what is our best curative plan?
  6. Do I need neoadjuvant therapy to increase breast conservation and tailor adjuvant options by response (pCR vs residual)?
  7. Will a genomic assay (e.g., Oncotype DX) change whether I need chemotherapy?
  8. Am I a candidate for lumpectomy with oncoplastic techniques, or is mastectomy preferable?
  9. Do I qualify for Z0011-type omission of axillary dissection or targeted axillary dissection after neoadjuvant therapy?
  10. What radiation fields (breast/chest wall, nodes) and schedule (hypofractionation, 5-fraction, boost) fit my case?
  11. How does reconstruction timing interact with radiation to optimize outcomes?
  12. Am I eligible for CDK4/6, PI3K/AKT/mTOR, PARP inhibitors, or ADCs (T-DXd, sacituzumab)?
  13. Should we test for ESR1/PIK3CA/AKT1/PTEN through ctDNA now or at progression to direct targeted therapy?
  14. What is our cardiac monitoring plan on HER2 therapy or anthracyclines?
  15. How will we detect and manage ILD risk on T-DXd and stomatitis on everolimus?
  16. What’s the plan for diarrhea on abemaciclib/capecitabine and hyperglycemia/rash on alpelisib/capivasertib?
  17. Should I pursue fertility preservation before chemo, and how would ovarian suppression fit in?
  18. Can I pause endocrine therapy in the future for pregnancy under supervision?
  19. How will we prevent lymphedema and bone loss, and what are my DEXA and bone-agent plans?
  20. Which clinical trials fit my biomarkers (ESR1, PIK3CA, BRCA/PALB2, HER2-low)?
  21. What is our imaging and clinic follow-up cadence during and after treatment?
  22. What support do you offer for fatigue, cognitive changes, sexual health, and return to work?