Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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 ...
Will you offer adjuvant abemaciclib to breast cancer patients with high Ki-67 who are unable to receive either neoadjuvant or adjuvant chemotherapy due to comorbidities or who decline chemotherapy?
Chemotherapy was given to the majority of patients on MonarchE because they were high risk at diagnosis. For patients at high risk, I will continue to offer chemotherapy in addition to adding adjuvant abemaciclib to endocrine therapy. For those patients who refuse or in whom adjuvant chemotherapy is...
Does the magnitude of benefit with 2 years of adjuvant abemaciclib outweigh side effects, given that many patients will receive CDK 4/6 inhibitors at breast cancer recurrence, precluding OS benefits?
In terms of balancing benefit in terms of risk reduction of cancer recurrence versus adverse events, this is always an important consideration in introducing a novel therapy. In patients who are at high risk based on the criteria for the trial, namely node positive based on more than 4 nodes or if 1...
How far can you dose reduce abemaciclib for a patient who is having toxicity at starting doses?
I think this is an extremely important question with broad applicability to drug dosing in general, and particularly in the elderly who not uncommonly are both less tolerant and less forgiving of side effects. If drug efficacy is truly maintained over a range of dosing and not just dose related rela...
Would you offer adjuvant abemaciclib plus endocrine therapy for favorable histology ER+/PR+/HER2-negative tumors such as pure tubular, mucinous, cribriform, or papillary that otherwise meet MonarchE trial criteria?
These pure subtypes are rare (<5%) and many pathology studies state that the term should be reserved for cases where at least 90% of the tumor is tubular or mucinous with low grade features to be considered favorable. In one retrospective study for over 100 G1 pure tubulars, only 5% had N1 disease a...