Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
For patients with prior HR+HER2- localized breast cancer currently receiving adjuvant endocrine therapy, is there a time period in which you would no longer recommend adding adjuvant abemaciclib?
This is a great question and I hope we eventually have data to guide us. I also do not know how insurers will handle these types of requests. This high-risk ER+ population has a 10-year risk of distant recurrence between 20 to 40% with continued risk of recurrence over 20 years based on the EBCTCG d...
Would you recommend adjuvant abemaciclib for ER+ HER2 neg inflammatory breast cancer who do not achieve pCR with neoadjuvant chemotherapy?
I would certainly consider it. It would be helpful to have additional information: How many LN were positive at diagnosis? What is Ki-67? Grade--likely grade 3 for inflammatory How much residual disease at surgery? Though none has given definitive answers to assist, these factors could play roles...
Would you give chemotherapy to a post menopausal woman with ER/PR positive HER2 negative breast cancer, T2N1 with 3+ lymph nodes, Ki-67 30% and OncoType RS of 10?
I would not give this postmenopausal woman adjuvant with a recurrence score of 10 based on RxPONDER trial. In that trial women with recurrence scores of 25 or less were randomized to receive chemotherapy + endocrine versus endocrine therapy alone. The Kaplan Meier curves were superimposable. I would...
What adjuvant systemic therapy would you give a patient with pN2 nodal relapse of ER+/HER2- breast cancer now s/p ALND, after initial mastectomy, adjuvant TC, and 5 years of endocrine therapy?
I'll give my thoughts, but appreciate others here as well. I'm assuming this patient is likely now post-menopausal, and also assuming that they had 5 years of endocrine therapy and then relapsed off of adjuvant therapy.I'm guessing the patient did not have radiation as they had a mastectomy and did ...
What factors would you consider when deciding between tamoxifen vs OFS/AI in premenopausal women with early stage HR+ breast cancer?
I think the question is asking when would I recommend tamoxifen alone versus aromatase inhibitor plus medical ovarian suppression with agents like goserelin or leuprolide in a premenopausal breast cancer patient. There are multiple factors to consider. If she has a history of active endometriosis or...
Do you recommend axillary dissection for women with ER+ breast cancer and low risk Oncotype or Mammaprint if single node positive with only 1-2 SLN removed, to ensure <4 nodes positive?
No, I see no need to do dissection in this setting. Unless there is clinical or imaging evidence of gross disease, radiation should adequately control microscopic residual disease in the axilla.
Under what circumstances would you pursue completion ALND in a patient with multiple positive sentinel nodes after breast-conserving surgery?
For clinical/imaging node-negative disease with 1-2 positive nodes, now there are 7 plus clinical studies (ACOSOG Z0011, AMAROS, OTOASOR, SENOMAC, IBCSG 23-01, AATRM, SINODAR-ONE) which have shown no difference in axillary recurrence, DFS with dissection, but higher lymphedema as expected. The most ...
How do you incorporate Oncotype or Mammaprint recurrence score when planning an adjuvant CDK4/6 inhibitor for high-risk early-stage HR+ breast cancer?
Oncotype DX and MammaPrint recurrence scores are not used to guide adjuvant cyclin-dependent kinase 4/6 (CDK4/6) inhibitor therapy in high-risk, early-stage, hormone receptor-positive breast cancer. However, they were used to further identify the node-negative patient population with T2 or greater t...
What factors do you use to decide between ribociclib and abemaciclib for high risk HR+/HER2− early breast cancer?
For women who are eligible for both, we discuss both, but I am biased towards ribociclib for certain. The QOL issues we have had with abemaciclib in the adjuvant setting have been outrageous. Despite best supportive care and dose adjustments, I have women severely limiting their daily activities aro...