Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Will you use ovarian function suppression in lieu of chemotherapy in premenopausal patients with pN1 ER+ HER2- breast CA with OncoType RS <25?
Most certainly. The difference between chemotherapy effect in postmenopausal vs. premenopausal women with ER+ breast cancer is not primarily due to a difference in disease biology. It is due to the endocrine effect of chemotherapy in premenopausal women and the lack of that effect in postmenopausal ...
Are you more inclined to offer adjuvant chemotherapy for a post-menopausal woman after lumpectomy for a small TNBC who has a concurrent metastatic ER+ breast CA?
This is an unusual situation. I would not give adjuvant chemotherapy to this patient who already has metastatic disease, even indolent metastatic disease. First, the chance of developing metastatic disease from the triple-negative breast cancer is not 100%, it's more like 20-40% depending on how sma...
What are your recommendations for post-menopausal patients who would fit into RxPonder trial criteria (HR+/HER2- breast cancer, 1-3 positive LNs) and have already started on adjuvant chemotherapy?
It would depend on where the patient is in the journey. If she is having problems with the chemotherapy, it might be beneficial to send in order to feel better if you are thinking of stopping chemo early anyway.
What is your neoadjuvant chemotherapy of choice in patients with ER+ breast CA who are receiving neoadjuvant therapy with goal to convert to BCS from mastectomy?
I have tried to use Dose dense doxorubicin and cyclophosphamide followed by dose dense paclitaxel (AC-T) in most situations in the neoadjuvant setting since lymph node status is not known definitively prior to surgery. There is adjuvant data from the ABC trial for non inferiority of docetaxel and cy...
What adjuvant treatment (if any) would you recommend for a post-menopausal patient with a borderline T1b (0.5 cm) grade 2 ER+/PR+/HER2 negative invasive lobular breast CA after bilateral mastectomies?
My evaluation and plan for any patient with breast cancer seen in the Stage 0-3 setting tends to follow a similar pattern. The risks include: Distant recurrence Local recurrence New breast primaries Side effects of therapy The systemic therapy options for lowering these 3 categories of risk in this ...
Should we start performing universal germline mutation testing for all newly diagnosed breast cancer?
The OlympiA study resulted in a statistically significant iDFS and DDFS benefit with adjuvant olaparib vs placebo in high-risk, HER2-negative patients with gBRCA mutation. Given the notable improvement in outcomes, it is imperative that every potentially eligible patient be considered for adjuvant o...
In a patient with HR+ breast cancer who is not able to tolerate adjuvant AI or standard dose tamoxifen due to side effects, would you consider a lower dose of tamoxifen?
Since we don't have data on the efficacy of low dose tamoxifen for treatment of invasive cancer, this would be a last resort. The TAM01 trial showed 5mg of tamoxifen was better than placebo for preventing recurrence in women with intraepithelial lesions. Anecdotally, I have had an occasional early s...
Would you modify the dose of aromatase inhibitors or selective estrogen receptor modulators in patients who have a history of gastric bypass or other malabsorptive conditions/surgeries?
This is an interesting question as we are certainly seeing more patients having weight loss surgeries. There is really limited data on the absorption of aromatase inhibitors (AIs) or selective estrogen receptor modulators (SERMs) after gastric bypass or other GI surgery. In general, drugs that are f...
Would you offer endocrine therapy to a patient who developed a new contralateral pT1b pN0 ER/PR+ HER2- breast IDC 1 year after coming off 10 years of anastrozole for prior invasive breast cancer?
I would offer the patient endocrine therapy but would use a different endocrine agent than one the patient had been on for the previously diagnosed contralateral breast cancer. Since this patient was on anastrozole for 10 years (a non-steroidal aromatase inhibitor), I would probably choose a steroid...
What is your treatment approach in a patient with cT2 ER+HER2+ breast cancer who refuses neoadjuvant chemotherapy?
Standard neo-adjuvant chemotherapy that contains trastuzumab, pertuzumab carboplatin, and docetaxel is recommended for most cases of HER2+ breast cancer (although other, anthracycline-containing regimens also exist but are used increasingly less commonly). If this patient refuses neo-adjuvant chemot...