Breast cancer case review with Dr. Jame Abraham

Thursday, November 21, 2019

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


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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Podcast Participants

David Henry, MD
David Henry, MD, FACP, is a clinical professor of medicine at the University of Pennsylvania and vice chairman of the department of medicine at Pennsylvania Hospital in Philadelphia. He received his bachelor’s degree from Princeton University and his MD from the University of Pennsylvania, then completed his internship, residency, and fellowship at the Hospital of the University of Pennsylvania. After 2 years as an attending in the U.S. Air Force, he was drawn to practicing as a hem-onc because of the close patient contact and interaction, and his belief that, win or lose with each patient, one can always make a difference in their care and lives. Follow Dr. Henry on Twitter: @davidhenrymd. Dr. Henry reported being on the advisory board for Amgen, AMAG Pharmaceuticals, and Pharmacosmos. He reported institutional funding from the National Institutes of Health and FibroGen.