Kathy D. Miller, MD; Hope Rugo, MD


December 20, 2013

In This Article

What About the Noneligible Patient?

Dr. Miller: I suspect that I know the answer to this question, but on Monday, when you are seeing a new patient with a 3-cm, triple-negative tumor who is not eligible for the I-SPY trial, is platinum part of her neoadjuvant therapy regimen?

Dr. Rugo: That is a good question. We saw at San Antonio that even with improved pCR rates with trastuzumab, lapatinib, and chemotherapy,[9] that didn't translate into an improvement in outcome, probably because there weren't enough patients and they all fell off because of toxicity. Nonetheless, we know we have to look at outcomes.

Dr. Miller: Are you giving her platinum or not?

Dr. Rugo: We don't have outcome data yet; that's the caveat. What should we do? This is a group of patients of whom one third will have a pCR. I like platinums; I enroll almost all of my patients in I-SPY 2. That is not as much of a question, but what should we do when we are not enrolling the patient? One idea is to give patients 3 weeks of paclitaxel, and if they don't have a great response, maybe we should be adding platinum in those patients. That is an interim approach that is quite intriguing, and with triple-negative disease, it's all or none. You want those patients to have a pCR now because I can't wait 2 years for the outcome for the patient I treat on Monday. That would be my approach in the nontrial setting right now. How about you, Kathy? What would you do?

Dr. Miller: If this is a healthy patient with more locally advanced disease, she needs a pCR. Although I hope we have the outcome data, I share your thoughts: This is not someone who can wait for those long-term data, so if the trial is not available, I find it hard to ignore these data and these results for her.

Dr. Rugo: Indeed. We are going to have to be less squeamish about growth factors and more nausea medication. That is one little tidbit to keep in mind if you plan to use platinum.

Dr. Miller: Thank you, Hope, for taking us through this complicated emerging area with some older drugs and some new ones.

Dr. Rugo: Thanks so much.

Dr. Miller: Thank you for joining us in this edition of Medscape Oncology Insights. This is Dr. Kathy Miller, reporting from the 2013 San Antonio Breast Cancer Symposium.


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