Wednesday, November 23, 2016


Progress in Breast Cancer treatment:

1. ER Positive

These tumors of course can be treated with Tamoxifen in premenopausal patient (some have required 2 years from last Menses to consider someone Post Menopausal) and Aomatase Inhibitors (AI) for post Menopausal.

In those with recurrent disease (or progression )
Anastrazole or Fulvestran being strong suggestions.
But the game has been improved as more options have been proposed
1.o.   Palbociclib(125) +   Letrozole(2.5)
check day 14 CBC for frequent episode of Neutropenia and fever
time to progression with this combination 22 Vs 14 months

2.o  for the 50% who will not respond to the first option
consider Everolimus + Entinostat
3.o  Everolimus  (10) +  Exemestane

watch for stomatitis,fatigue,Dyspnea,Hyperglucosuria, LFTs, and pneumonitis

4.o   Palbociclib   +   Fulvestran
5.o   Monarch 1 may have proposed Abemaciclib as an option in these instances
6.o   Abemaciclib can be combine with either Letrozole or Fulvestran
7.o   don't forget that Entinostat can also be proposed in combination with Examestane

These same agents can be used in Neoadjuvant setting, when confronted with Locally advanced disease for 16-18 weeks prior to definitive surgery.

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