Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would you advise a breastfeeding woman with localized HR+ breast cancer in terms of risk of progression with breastfeeding prior to local therapy with surgery?
For every 12 months of breastfeeding, the risk of developing breast cancer is lowered by about 4%. I know of no data that describes increased risks of progression prior to surgery regarding ER-positive breast cancer. However, the breasts are engorged during breastfeeding, and they involute when stop...
Do you consider adjuvant chemotherapy for older women >75 years of age, with HR+ invasive ductal carcinoma and 3 positive LN however intermediate risk recurrence scores?
Until the prospective data from RxPONDER is out, we only have retrospective data for node + disease. Based on the Israeli Registry study, 2-3+ node patients with scores under 18 had a 5-year recurrence rate of 5.4%. For N+ patients, the recurrences were lower for chemo vs no chemo (1% vs 9.7%) in th...
Would you offer adjuvant chemotherapy to a premenopausal patient with ER/PR+ breast cancer, nodal micrometastasis, low OncotypeDx score but also BRCA2 carrier?
A breast cancer developing in a BRCA2 mutation cancer has the same prognosis as a non-mutation carrier (Robson et al., PMID 14680495), I would follow the low Oncotype score (assuming it is not 21-25) and treat her accordingly. If child-bearing is not a concern, and she is over 35 years, then bilater...
How do the new RxPONDER results affect your choice of adjuvant therapy for postmenopausal women with HR+/HER2 negative breast cancer and 1-3 positive lymph nodes?
The RxPonder trial results show that in postmenopausal women with 1-3 positive nodes and recurrence scores under or equal to 25, there was no benefit for chemotherapy added to endocrine therapy versus endocrine therapy alone. Whereas, for those with recurrence of 26 or above, I would offer chemother...
What is your approach to adjuvant hormone therapy for HR+ breast cancer in post-menopausal women with pre-existing osteoporosis?
Pre-existing osteoporosis, I assume secondary causes of osteoporosis and vitamin D3 deficiency have been ruled out, and she is on antiresorptive medications. In this case, I would use tamoxifen. In postmenopausal osteoporosis, tamoxifen mitigates bone loss but does prevent fractures. Suppose there a...
Do you plan to offer adjuvant olaparib to all gBRCA+ breast cancer whether TNBC or HR+?
I offer adjuvant olaparib to germline BRCA mutated breast cancer patients (TNBC or hormone receptor positive and Her-2 negative) only if they meet the inclusion criteria that was used in the OlympiA study, which is as follows:1) Patients with triple-negative breast cancer who were treated with adjuv...
How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?
Assuming that the patient's metastatic work-up is negative, and that the local recurrence is in the breast, limited in volume and resectable, standard local management would be a mastectomy, without post-mastectomy radiation (as she presumably received radiation after her lumpectomy). I also assume ...
In what scenarios do you consider omitting adjuvant endocrine therapy after lumpectomy for DCIS?
NSABP 24, 35 Trials. Adjuvant hormone therapy prolongs DFS.
Do you treat early stage multifocal breast cancer similarly to single site lesion?
Anatomic staging of multifocal disease is based on the largest lesion. Various investigators have examined prognostic implications of multifocality or multicentricity and have generally concluded that the current system of staging is still most appropriate, but that the presence of more than one tum...
Would you offer adjuvant Abemciclib to ER positive HER2 negative with 1 LN positive, Ki-67 >20%, and low Oncotype?
Yes. The low Oncotype DX RS should not alter the standard use of abemaciclib in this setting.