Jame Abraham, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia to review two cases of breast cancer, focusing on when to use the 21-gene Oncotype DX breast recurrence score and how to apply the results.  

Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, explores what happens when the patient minimizes their symptoms in order to keep getting treatment.

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This Week in Oncology

Not all lung cancer patients receive treatment

By Richard Franki

In the United States, just over 15% of patients with lung cancer receive no treatment, according to the American Lung Association.

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Breast cancer cases

Case 1:

A 46-year-old, premenopausal woman who has had a right breast lumpectomy with a 7-mm tumor that is invasive ductal, ER/PR positive, and HER2 negative. Since her tumor is small and low grade, would you do Oncotype DX recurrence score testing?

Dr. Abraham recommends:

Explain to the patient that her benefit from chemotherapy will be limited, but that she meets the tumor size requirement for the Oncotype DX assay and offer her the test.

Case 2:

A 57-year-old women who is postmenopausal with a grade 1 tumor that is 10mm, ER/PR positive, HER2 negative, with 4 of 17 positive lymph nodes. Is there an advantage to adding the Oncotype DX testing for this patient?

Dr. Abraham recommends:

Offer the patient chemotherapy; recommend against Oncotype DX testing.

Show notes by Mary Ellen Schneider

 

References

Sparano JA et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018 Jul 12;379(2):111-21.

Sparano JA et al. Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med. 2019 Jun 20;380(25):2395-2405.

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Ilana Yurkiewicz on Twitter: @ilanayurkiewicz