Would you treat a premenopausal woman with T2N0 ER-, PR+ (15-20%), HER2- breast cancer with neoadjuvant chemotherapy like a triple negative breast cancer?
Answer from: Medical Oncologist at Academic Institution
Yes, I would treat this patient with neoadjuvant chemotherapy as I would for a "triple-negative" breast cancer as certainly the biopsy of an ER 0%, weakly PR positive tumor is similar. I would not send an OncoType on this tumor - if it was low or intermediate, I still would not trust this patient wo...
Answer from: Medical Oncologist at Academic Institution
Yes, I would treat her as a triple-negative patient and would not expect any benefit from adjuvant endocrine therapy. I also wouldn't waste the time or money to send a genomic assay, such as Oncotype, Mammoprint, or EndoPredict, as any of these are sure to confirm that this is a high-risk cancer tha...
Answer from: Medical Oncologist at Academic Institution
Multiple pathology papers report that this is more likely than not a technical artifact and repeat staining should be done. Most of the time it will not be ER-PR+ on repeat stain (for example see Foley et al., PMID 28891017). This was specifically addressed in the recent ASCO/CAP guidelines for ER a...
Answer from: Medical Oncologist at Community Practice
First, I would repeat the PR. Also, calculate an Allred score. There are only 1% of cases where PR is + with a negative ER. Shouldn't happen. This is most times an anomaly and will be negative upon repeat. Then treat as triple-negative. There is no role for any other testing such as Oncotype or Endo...
Answer from: Medical Oncologist at Academic Institution
I would get an OncoType Dx assay or a Mammoprint/Blueprint on the biopsy and treat it as per the results of that. She is not triple-negative breast cancer, but may well benefit from chemotherapy. There is increasing experience with using OncoType DX on neoadjuvant biopsies (Yardley et al., PMID 2650...
Answer from: Medical Oncologist at Community Practice
We are starting to use EndoPredict in order to determine which patients can be "de-escalated" and avoid neoadjuvant chemotherapy, and which HR+/HER2- patients would benefit from it.Almstedt et al., PMID 32436145
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Medical Oncologist at Regional Cancer Care Associates, LLC Is it better than Oncotype?