Topics:
Lung Cancer • Breast Cancer • Radiation Oncology • Thoracic Malignancies • Medical Oncology • Non-small cell lung cancer
How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?
The left breast cancer is an ER-negative, PR-negative, HER2-negative cT2N0 invasive ductal carcinoma, while the left lung primary is a cT2N1 squamous cell carcinoma.
What is the appropriate approach and sequence of therapies in this case of synchronous primaries?
Answer from: Radiation Oncologist at Community Practice
The presentation of two primary cancers that carry serious prognoses is very challenging. There are many variables at play here that could alter the initial therapeutic approach and ongoing treatment. Assuming this patient has a reasonable KPS, PFTs, and can undergo surgery, one way to start is neoa...
Sign in or Register to read more
Answer from: Medical Oncologist at Academic Institution
This is a tough one to juggle as prolonging therapy for the TNBC could adversely affect the NSCLC or vice versa. If the patient is appropriate for it, I would attempt a platinum/taxane/aPD-1 for 4 cycles and assess response in the breast with MRI along with repeat imaging of chest. The most straight...
Answer from: Medical Oncologist at Academic Institution
I would treat her according to the KEYNOTE-522 trial with carboplatin, taxane, and pembrolizumab. This would be excellent therapy for the breast cancer, and carboplatin/Taxol/immunotherapy would also be a standard regimen for squamous cell carcinoma of the lung (though typically an immunotherapeutic...
Comments
Medical Oncologist at University of Utah Huntsman Cancer Institute
Excellent answer as always from my greatest mentor...
Excellent answer as always from my greatest mentor...
Answer from: Medical Oncologist at Community Practice
Agree, this is a tough case. Treating two separate histologies and two separate organs is very challenging. I am guessing that metastases have been ruled out in either case and we are treating two primaries at the same time. Given that both are aggressive pathologies, our goal is cure in this contex...
Answer from: Medical Oncologist at Community Practice
No single source of evidence will point to a clear answer here. One consideration is neoadjuvant carboplatin, paclitaxel, and pembrolizumab X 3 cycles followed by repeat imaging for both tumors. Assuming no progression of either malignancy, would proceed to sequential surgery for each tumor based on...