Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a locally recurrent HER2 positive breast cancer patient previously treated with TCHP, lumpectomy, and a year of adjuvant TDM-1?
Assuming that the patient's metastatic work-up is negative, and that the local recurrence is in the breast, limited in volume and resectable, standard local management would be a mastectomy, without post-mastectomy radiation (as she presumably received radiation after her lumpectomy). I also assume ...
In what scenarios do you consider omitting adjuvant endocrine therapy after lumpectomy for DCIS?
NSABP 24, 35 Trials. Adjuvant hormone therapy prolongs DFS.
Do you treat early stage multifocal breast cancer similarly to single site lesion?
Anatomic staging of multifocal disease is based on the largest lesion. Various investigators have examined prognostic implications of multifocality or multicentricity and have generally concluded that the current system of staging is still most appropriate, but that the presence of more than one tum...
Would you offer adjuvant Abemciclib to ER positive HER2 negative with 1 LN positive, Ki-67 >20%, and low Oncotype?
Yes. The low Oncotype DX RS should not alter the standard use of abemaciclib in this setting.
Would you offer adjuvant olaparib to a male patient with HR+, HER2- T2N0 breast cancer with a BRCA2 germline mutation following mastectomy who is not a candidate for adjuvant chemotherapy?
Will offer brief thoughts but welcome others as well. First, I think it would be helpful to know what risk stratification has been done to decide the patient should be offered chemotherapy and not just endocrine therapy. Also, it would be useful to know why they are not a candidate for chemotherapy ...
How would you approach adjuvant systemic therapy in a HR+ premenopausal patient over the age of 50?
Since you are citing the RxPONDER study, I assume this is a premenopausal woman over age 50 with N1 node positive disease.In the RxPONDER study, for premenopausal women, the 5-year HR for iDFS with chemo was 0.6. Same for distant DFS. But the benefit was mainly seen in premenopausal women under 50. ...
How would you manage a HR+/HER2+ breast cancer patient with no response during neoadjuvant TCHP?
A few thoughts: Although we know that patients with ER+/HER2+ are less likely to respond to neoadjuvant chemo and dual HER2-targeted therapy than those who are ER-/HER2+, I would confirm that the patient is truly HER2+; if the diagnosis was made by IHC, would send FISH or CISH. If the patient has ...
In which scenarios do you use vaginal estrogen in patients with history of HR positive breast cancer?
A recent study (McVicker et al., PMID 37917089) supports the likely safety of vaginal estrogens in breast cancer survivors. Limitations of this study are that it primarily included lower-risk individuals with stage I-II disease and women 50+. In addition, the level of data is limited by the retrospe...
When do you recommend preoperative chemotherapy or hormonal therapy for ER+ breast cancer?
While trying to downstage the patient's tumor to make her a better candidate for breast-conserving surgery or to improve her cosmetic outcome is the primary reason why I administer neoadjuvant therapy in patients with HR+/HER2- breast cancers, there are occasionally other reasons, including delaying...
Do you think about CDK4/6 inhibitor selection differently in a patient with de novo rather than recurrent metastatic disease?
Not really. Would recommend endocrine therapy with CDK 4/6i for both patients with de novo metastatic disease and those with disease recurrence. The type of endocrine therapy might vary though - would consider Fulvestrant as endocrine therapy partner for a patient who has disease recurrence on adjuv...