Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you view the use of adjuvant CDK4/6 inhibitors overall given discordant results between MonarchE and PALLAS?
Given the final results of PALLAS (SABCS 2021), there is no role for adjuvant palbociclib in high risk ER positive breast cancer at this time. No subgroup seemed to benefit. We await the extensive translational studies to get a better idea of what went on with the trial. 45% of patients discontinued...
Would you offer adjuvant abemaciclib to node-positive patients with low ER expression?
This tumor is likely biologically similar to a triple negative tumor, thus it is not surprising that it has a high Ki67. More information is really needed on if/what neoadjuvant therapy this patient received to better answer this question.Although both KEYNOTE-522 and monarchE use the ASCO-CAP guide...
How would you treat an elderly patient with borderline cardiac dysfunction who has stage 3 HR+ HER2- breast cancer?
If she has an invasive lobular carcinoma and is a borderline candidate for chemotherapy, can possibly try using neoadjuvant letrazole for 3-6 months with close monitoring with breast MRI every 2 months to make sure there is no progression and assess response. If she is lucky and has CR/PR, then poss...
How and on which specimens will you perform Ki-67 testing in newly diagnosed breast cancer?
In the trial, Ki67 testing was performed on the baseline tumour sample which would be a core biopsy of patients who are undergoing neo-adjuvant chemotherapy, which occurred in 37% of patients in the trial, or the surgical excision sample if they went straight to surgery. It is important that it is d...
Would you hold abemaciclib during adjuvant chest wall/axillary radiation after mastectomy?
I agree. There are some concerns that put cells into cell cycle arrest may also impact the benefits of radiation therapy. So it is recommended to hold abemaciclib during radiation therapy.
Would you provide abemaciclib to a premenopausal women with cT2 cN1 ER+ breast cancer and Ki67 of 80% who achieves pCR following neoadjuvant AC-T?
Patients who received neoadjuvant Chemotherapy were only eligible for the trial if they had residual disease above a threshold quantified using CPS-EG.
If you have a high risk HR+, BRCA+ breast cancer patient who qualifies for adjuvant olaparib and abemaciclib, which one would you give and why?
The results of the recent OympiA trial published in the New England Journal of Medicine by Tutt et al. for women with high risk BRCA positive breast cancer, together with the MonarchE trial for high-risk ER positive breast cancer, has created somewhat of a dilemma as to which therapy to add to patie...
Would you offer adjuvant AI + abemaciclib to a post-menopausal, node + luminal A breast cancer that did not require chemotherapy per Oncotype, yet still met criteria per monarchE?
I think it is reasonable to offer this patient adjuvant abemaciclib even though the benefit of chemotherapy is expected to be low or nil based on the 21-gene (Oncotype) recurrence score, since the overall risk of recurrence would be higher based on the anatomic stage. In fact, the RSClin scoring sys...
What would be your adjuvant treatment approach for patients with hormone receptor-positive breast cancer who have not responded to neoadjuvant aromatase inhibitor endocrine therapy?
There are some details that are important in answering this question as for example, how lack of response was defined and how long was the patient on neo-adjuvant endocrine therapy. Response to endocrine therapy takes several weeks to a couple of months and neo-adjuvant trials showed a very low rate...
When would you use adjuvant abemaciclib in patients with clinically high-risk ER+, HER2-negative breast cancer, but pCR following neoadjuvant chemotherapy?
This patient would not have qualified for the monarchE adjuvant abemaciclib protocol, which used pathologic staging for lymph node status (although baseline imaging was allowed for tumor size determination in patients who received adjuvant chemotherapy) (1). This is in contrast, for example, to the ...