Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For premenopausal patients with ER+ PR+ HER2 negative breast cancer and lymph node micrometastases, would recurrence score be most appropriately interpreted based on TAILORx data, given such patients were excluded from RxPONDER?
These patients were excluded from TAILORx. Patients with micrometastases were initially allowed in RxPONDER but then excluded after the first ~2500 patients had been enrolled (presumably because too many patients with micromets were being enrolled and the study team wanted to ensure results would be...
In a patient with early stage HR+ breast cancer who was perimenopausal at diagnosis but intolerant of AI, would you consider extending tamoxifen beyond 10 years?
ATLAS and aTTom trial : - 10 years of extended adjuvant Therapy. In absence of data, I will not extend Adjuvant Therapy.
Would you use aspirin 81 mg for VTE prophylaxis in patients on adjuvant tamoxifen/SERMs?
In a meta-analysis of over 30,000 patients, VTE was found in 2.8% of patients on tamoxifen and 1.6% of patients on AI. So, yes there is a higher risk of VTE on tamoxifen but the percentage is still very low. I would not use 81 mg aspirin as VTE prophylaxis in all patients on tamoxifen to rescue or p...
Would you use aspirin 81 mg for VTE prophylaxis in patients on adjuvant tamoxifen/SERMs?
In a meta-analysis of over 30,000 patients, VTE was found in 2.8% of patients on tamoxifen and 1.6% of patients on AI. So, yes there is a higher risk of VTE on tamoxifen but the percentage is still very low. I would not use 81 mg aspirin as VTE prophylaxis in all patients on tamoxifen to rescue or p...
How would you manage adjuvant therapy for a premenopausal female with a T1cN1mi breast IDC that is HR+ HER2 positive on biopsy, but HR+ HER2 negative on lumpectomy surgical specimen?
Overall, I agree with Dr. @Dr. First Last's response regarding treating this as a heterogenous tumor, but I would probably lean towards 4 cycles of TC (docetaxel/cyclophosphamide) for the HR+/HER2 neg component and then add 1 year of trastuzumab. This would avoid the risks of anthracyclines and pert...
How do you approach adjuvant therapy to minimize cardiotoxicity in early stage node negative HER2+ HR+ breast cancer with history of chest wall radiation and previous cardiotoxic agents for Hodgkin Lymphoma?
The recommended adjuvant treatment approach for a middle-aged patient with a history of mantle cell radiation for Hodgkin lymphoma and early-stage node-negative bilateral HER2+ HR+ breast cancer, while minimizing cardio toxicity, involves a multidisciplinary approach. Given the patient's history of...
Which chemotherapy is preferred between TC and AC-T in a young patient with ER+/PR+/HER2- node negative breast cancer, intermediate grade, with high OncoType score?
If this patient has a small, node negative, hormone receptor positive, HER2 negative intermediate grade tumor, I would be comfortable with recommending 4 cycles of adjuvant docetaxel and cyclophosphamide. Based on ABC trial results, the groups that benefited from AC-T regimen were patients with high...
Does a complete pathologic response to neoadjuvant chemotherapy affect the duration of endocrine therapy/OFS that you recommend for a premenopausal patient with HR+/Her2+ breast cancer?
This is a great question. In my practice, I do not alter duration of endocrine therapy based on response to chemo. Luminal tumors less commonly achieve pCR, and degree of response to neoadjuvant chemotherapy is less reliable as a prognostic factor in luminal tumors compared to TNBC and HER2+ tumors....
Would you consider adjuvant endocrine therapy for DCIS in a patient who received bilateral nipple-sparing mastectomies?
No. This is chemoprophylaxis, and the very small amount of remnant breast tissue does not denote a risk of subsequent breast disease high enough to justify the toxicities and risks of endocrine therapy.
Are Mammaprint and OncotypeDx as useful in stratifying risk in patients with early stage HR+, HER2 negative lobular carcinomas, as in those with ductal carcinomas?
OncotypDX is not very useful in stratifying patients with early stage HR+ HER 2 negative invasive lobular carcinoma. Several studies (MD Anderson, Penn State) have shown that only 1-2 % of invasive ILC cancers are classified as High risk therefore receiving strong recommendation for chemotherapy. Si...