Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a premenopausal female with cT2cN0 HR+/HER2-negative breast cancer who received neoadjuvant TC for high OncoType, had no pathologic response to therapy and upstaged to pT2N1 on surgery?
There is definitely a shift in administering more neoadjuvant therapy in ER+Her2- disease. However, I tend to avoid the use of TC in the neoadjuvant setting as the treating oncologist can be left with this conundrum. However, with the COVID pandemic and other reasons that may be needed to delay surg...
Would you consider a CDK 4/6 inhibitor in combination with endocrine therapy for a patient with ER low (1-9%) metastatic breast cancer?
Whereas ER 1-9% represents a heterogeneous group of tumors with relatively poor response to endocrine monotherapy, there are few if any data on whether this group of patients should be excluded from the use of CDK 4/6 inhibitors. For example, Finn et al. demonstrated that in the PALOMA-2 study, ER H...
Would you offer adjuvant abemaciclib + an aromatase inhibitor to a patient with a local HR+HER- breast cancer reoccurrence while on tamoxifen that meets high-risk criteria?
I would consider using abemaciclib and aromatase inhibitor therapy for a local recurrence while on adjuvant tamoxifen for someone who otherwise met the criteria for adjuvant therapy based on the FDA approval upon results of the monarchE trial (1). While not formally tested in this population, the on...
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...