Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you give chemotherapy to women with clinical features of high risk ER+ breast cancer, but a low Oncotype DX score?
I wouldn't consider chemotherapy in this patient but some would. I will try to briefly summarize the arguments on both sides. - Prior to oncotype, we made the decision about chemo based on anatomic risk alone. If the risk of recurrence was predicted to be 10% or greater, guidelines suggested chemoth...
Do you discontinue anti-hormonal therapy if a high-risk ER+ HER2- localized breast cancer patient develops blood clots on anti-hormonal therapy?
Tamoxifen has been associated with an increased risk for venous thromboembolic events, but there does not appear to be any increased risk with the aromatase inhibitors in the placebo controlled studies. These include MA.17, MA.17R in the extended endocrine therapy setting and MAP.3 and IBISII in the...
What other chemotherapy would you consider in a patient with high-risk node positive ER+, HER2- disease that developed pulmonary toxicity to paclitaxel and refuses any more taxanes?
This is certainly a tough situation, but one that comes up when we cannot complete what we think is sufficient adjuvant therapy with the taxane portion of the adjuvant chemotherapy regimen, AC-weekly Taxol. In most cases, we would consider an alternate taxane, but not in this case because the patien...
Do you discontinue anti-hormonal therapy if a high-risk ER+ HER2- localized breast cancer patient develops blood clots on anti-hormonal therapy?
Tamoxifen has been associated with an increased risk for venous thromboembolic events, but there does not appear to be any increased risk with the aromatase inhibitors in the placebo controlled studies. These include MA.17, MA.17R in the extended endocrine therapy setting and MAP.3 and IBISII in the...
Is there a role for the neoadjuvant use of CDK 4/6 inhibitors with endocrine therapy in patients with well differentiated and/or invasive lobular histology who desire breast conservation?
The role of neoadjuvant CDK4/6 inhibitors has been explored in multiple phase 2 trials including the neoMONARCH and PALLET trials. The data from these studies suggest that abemaciclib and palbociclib are active in ER+ early stage breast cancers by causing a more complete arrest of tumor cell prolife...
How would you treat a postmenopausal woman with recurrent, localized ER+,HER2- breast cancer to the contralateral breast while on AI?
Assuming this a new primary, you would treat it like another primary breast cancer with breast surgery +/- radiation. If clinically appropriate you would send genomic testing (i.e., Oncotype or Mammoprint) to make decisions about adjuvant chemotherapy. The contralateral breast cancer (CBC) recurrenc...
What factors influence whether you order OncotypeDx in HR+ node negative ILC?
If there is differential ER/PR expression or other high risk features such as pleomorphic features or high grade.
Would you use neoadjuvant CDK4/6 inhibitor and AI in HR+ breast cancer based upon the randomized phase II CORALLEEN trial?
I would not use CDK inhibitors in the neoadjuvant setting.
Would you consider adjuvant capecitabine in a premenopausal patient with HR-positive inflammatory breast cancer who had residual disease after neoadjuvant chemotherapy?
Yes, I would consider adjuvant capecitabine for a patient with residual invasive disease after standard neoadjuvant chemotherapy (NAC) for HR+ inflammatory breast cancer. Given the uncertainties about the absolute benefit in recurrence and mortality in this specific situation, I would discuss this w...
How would you approach adjuvant therapy for a young post-menopausal woman with a grade 3 pT1a (5mm) node negative ER+/HER2- invasive ductal carcinoma?
There is no data from the prospective trials to support genomic testing in T1a tumors. TAILORx did not enroll T1a tumors. A G3 tumor under 1cm is clinically low risk so Mammaprint would not have clinical utility either. Since NCCN doesn't recommend chemotherapy in this scenario, I would not test.