Expert Point of View: Virginia Kaklamani, MD, and William Sikov, MD


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Virginia Kaklamani, MD

William Sikov, MD

There is a gray area between overtreatment and undertreatment, and it is our responsibility to conduct the right studies and get the data to help make the correct decision.

—Virginia Kaklamani, MD

This study was started in 1977. In this subgroup of premenopausal women with high-risk breast cancer but luminal A subtype, data suggest that there is no benefit from chemotherapy,” said Virginia Kaklamani, MD, leader of the Breast Cancer Program at the Cancer Therapy and Research Center and Professor of Medicine at The University of Texas Health Science Center in San Antonio. Dr. Kaklamani moderated a press conference at the San Antonio Breast Cancer Symposium where these data were discussed.

Exciting Data

“We have prospective data on genomic profiling of tumors showing that these patients have a very good prognosis. We also have data on postmenopausal node-positive patients suggesting that chemotherapy does not benefit subtype luminal A breast cancer,” she said.

“These data in premenopausal women are exciting,” she continued. “In our practice, we would consider not giving chemotherapy to postmenopausal women with luminal A subtype, but not in younger women.”

“Until we have randomized controlled data, these data appear to confirm that we probably don’t need chemotherapy for younger women with luminal A breast cancer. This study gives me more confidence not to give chemotherapy to my premenopausal patients,” she said.

Open Question

“We deal with these questions every day in clinical practice. In node-positive women, we often give chemotherapy even if they have less aggressive cancers. In patients with hormone receptor–positive cancers, we don’t know how much we are benefitting patients with chemotherapy on top of hormone therapy. That is an open question,” said William Sikov, MD, Associate Professor of Medicine at Brown University, Providence, Rhode Island, at the press conference.

“We need a large body of evidence with modern therapy. This study is a step in that direction. At some point, we will have to make the decision about whether we can safely withhold chemotherapy,” Dr. Kaklamani said.

“We have to take into account patient preference. There is a gray area between overtreatment and undertreatment, and it is our responsibility to conduct the right studies and get the data to help make the correct decision,” she stated.

“It is not good if decisions are made based on fear and lack of understanding. We need to get the data and educate women,” she added. ■

Disclosure: Drs. Kaklamani and Sikov reported no potential conflicts of interest.

 


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