What neoadjuvant therapy would you choose for a post menopausal woman with ER negative, PR positive high grade node negative breast cancer?
Would you consider genomic assays before neoadjuvant chemotherapy? How would you modify your treatment given the COVID-19 pandemic?
Answer from: Medical Oncologist at Academic Institution
Assuming that there is no reason to doubt the results of the hormone receptor testing, and her HER2 is negative, I would treat her the same way I would a triple-negative cancer—I would not bother to send Oncotype as it should be high with the negative ER, and I wouldn't believe it if it came b...
Answer from: Medical Oncologist at Academic Institution
Most hormone-responsive breast cancers are either ER positive and PR positive, or ER positive and PR negative. Tumors that are ER negative and PR positive are unusual. I would first obtain assurance from the laboratory that quality control for hormone receptor testing was rigorously followed (proper...
Comments
Medical Oncologist at Beverly Hills Cancer Center Agreed.
Medical Oncologist at Moffitt Cancer Center Would you consider endocrine therapy in this patie...
Answer from: Medical Oncologist at Community Practice
@William M. Sikov makes a key point from the ABC trials in that TC was inferior to dose dense AC followed by paclitaxel in node positive triple negative patients (this patient essentially is triple negative).For that reason, I tend to avoid TC as neoadjuvant treatment even in small tumors, as I'm no...
Answer from: Medical Oncologist at Community Practice
The expression of PR receptor is dependent on the Estrogen pathway. The presence of PR in the absence of ER either implies a false neg ER or a false positive PR (IHC). Retesting IHC on a different specimen should help. Prognostic outcomes for ER- and PR+ cancers are intermediate between ER+ and trip...
Answer from: Medical Oncologist at Community Practice
Agree with @William M. Sikov.
If the tumor is T1a and HER2 negative and Ki 67 is below 20...observation is another option, as with some T1a triple negative tumors (assuming the neoadjuvant part is due to COVID-19 and not due to tumor related reasons). Also at this time, I would prefer TC rather tha...
Comments
Medical Oncologist at Oncology of NorthShore A recent article was published on ER- PR+ breast c...
Medical Oncologist at Warren Alpert Medical School of Brown University I like the docetaxel/carboplatin x 6 regimen as ne...