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Topics:
Breast Cancer • Medical Oncology
Would you offer further systemic therapy to a patient with triple-negative breast cancer treated with neoadjuvant chemotherapy, BCT, and adjuvant capecitabine who has a local failure while receiving capecitabine?
After mastectomy for the locally recurrent disease, would you consider "pseudo-adjuvant" chemotherapy for local recurrence per the CALOR trial? If so, which regimen as she has been exposed to AC, paclitaxel/carboplatin, and capecitabine. Would you consider CMF? She has been fairly chemo-refractory to AC & paclitaxel/carboplatin (high residual disease burden), and capecitabine (developed local recurrence).
Answer from: Medical Oncologist at Community Practice
A very tough situation. There are times when I’ve yearned to have a patient-derived xenograft model running so I can test and evaluate for chemo sensitivity. There are no such tests like that now, and the in vitro chemo sensitivity assays have not been validated. To add to this point, if we pe...
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Answer from: Medical Oncologist at Academic Institution
This is indeed a difficult clinical situation. Given her brisk recurrence despite aggressive neoadjuvant and adjuvant chemotherapy, I would consider her to have chemotherapy-resistant disease. I would agree with the consideration of radiation, but would not recommend another course of ch...
Answer from: Medical Oncologist at Community Practice
Recheck ER, PR and HER-2
on recurrent tissue
Answer from: Medical Oncologist at Academic Institution
Appreciate the thoughts/comments. To expand, this patient did already receive adjvuant/local RT as part of her initial breast conserving therapy. Her biomarker status was rechecked upon recurrence and remained triple-negative.
A thought was could the pseudo-adjuvant/2nd adjuvant course c...
Answer from: Medical Oncologist at Academic Institution
Given how quickly she recurred locally on capecitabine, her tumor cells must be resistant to it, so I have little enthusiasm to continue this treatment, nor do I advise exposing her to other chemotherapy drugs with little likelihood of benefit. The SWOG trial is one idea, if she's eligible. Wou...