How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?
How would this change if the patient had metastatic HR+,HER2- breast cancer and now has symptomatic pancytopenia secondary to BM involvement after TCHP?
Answer from: Medical Oncologist at Academic Institution
Symptomatic bone marrow involvement (bone marrow carcinomatosis) is extremely rare in metastatic breast cancer and carries very poor prognosis. It is often associated with microangiopathic hemolytic anemia and DIC. Anemia is the most common manifestation and WBC and platelet counts are often not tha...
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Medical Oncologist at Penninsula Cancer Institute Having had a couple of patients who have survived ...
Medical Oncologist at Premier Physicians network I've had two patients, both had invasive lobular c...
Answer from: Medical Oncologist at Academic Institution
Bone marrow invasion in breast cancer is not uncommon, but it is typically focal in distribution and does not affect the blood counts, unless it becomes diffuse. Once there is diffuse spread, patients develop increasing degrees of anemia and thrombocytopenia, and less often some degree of neutropeni...
Answer from: Medical Oncologist at Academic Institution
Assuming this patient has progressed through AI+CDK4/6, SERD+CDK4/6 and there is no evidence of PI3KCA mutation or BRCA mutation on NGS, I would recommend capecitabine given the ease of administration/monitoring and transfusion support PRN. I would consider EPO, and would recommend IV Iron if the pa...
Answer from: Medical Oncologist at Community Practice
If the degree of bone marrow involvement is mild to moderate resulting in mild to moderate pancytopenia, I have seen very good results with various CDK4/6 agents. Otherwise, single agent chemotherapy is recommended. I usually start with weekly taxol with reduced dose sometimes.
Answer from: Medical Oncologist at Academic Institution
Definitely a challenging clinical situation. I agree that cytotoxic chemotherapy should be administered based on the smaller studies mentioned by@Praveen Vikas.
Due to ease of oral administration of capecitabine (although with a different side effect profile) and not being myelosuppressive, that wo...
Having had a couple of patients who have survived ...
I've had two patients, both had invasive lobular c...