Patterns of Care in  Medical Oncology Adjuvant Endocrine Therapy
What endocrine therapy, if any, would you recommend for a  55-year-old postmenopausal  woman with a 1.2-cm, Grade II, ER-p...
What endocrine therapy, if any, would you recommend for a  55-year-old postmenopausal  woman with a 1.2-cm, Grade II, ER-p...
What endocrine therapy, if any, would you recommend for a  35-year-old  woman with a 1.2-cm, Grade II, ER-positive, PR-pos...
What endocrine therapy, if any, would you recommend for a  35-year-old  woman with a 1.2-cm, Grade II, ER-positive, PR-pos...
What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-ne...
What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-ne...
What endocrine therapy do you generally recommend for postmenopausal women with ER-positive, HER2-negative, node-negative ...
When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI?  2007 2006 2005 Clinic...
When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI?  2007 2006 2005 Practi...
What percent of your patients on adjuvant AIs have significant  arthralgias  to the point that you  consider discontinuing...
What action would you take initially when you consider discontinuing or switching agents with patients who have significan...
What percent of your patients on adjuvant AIs have significant  vasomotor symptoms to the point that you  consider interve...
What action would you take initially when you consider interventions with the patients who have significant vasomotor symp...
What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-posit...
What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-posit...
What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-posit...
What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-posit...
Which of the following best describes the action you would take in the following scenarios? A  60-year-old woman  was trea...
Which of the following best describes the action you would take in the following scenarios? A  60-year-old woman  was trea...
Which of the following would you recommend in the following scenarios? A  61-year-old  woman was treated 5 years ago at ag...
Which of the following would you recommend in the following scenarios? An  81-year-old  woman was treated 5 years ago at a...
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POC Breast 1 | 2007 - Adjuvant Endocrine Therapy

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POC Breast 1 | 2007 - Adjuvant Endocrine Therapy

  1. 1. Patterns of Care in Medical Oncology Adjuvant Endocrine Therapy
  2. 2. What endocrine therapy, if any, would you recommend for a 55-year-old postmenopausal woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? 2007 2006 2005 Clinical investigators (CI) 0% 14% 2% 84% 2% 0% Other 16% 2% 82% 9% 0% 89% Tamoxifen for 2-3 years, then switch to an AI Tamoxifen for 5 years, then switch to an AI Al alone
  3. 3. What endocrine therapy, if any, would you recommend for a 55-year-old postmenopausal woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? 2007 2006 2005 Practicing oncologists (PO) 5% 5% 6% 84% 7% 4% Other 8% 8% 80% 9% 4% 80% Tamoxifen for 2-3 years, then switch to an AI Tamoxifen for 5 years, then switch to an AI Al alone
  4. 4. What endocrine therapy, if any, would you recommend for a 35-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? * If patient becomes postmenopausal 2007 2006 2005 Clinical investigators (CI) 2% 13% 2% Other 12% 0% 0% Tamoxifen for 2-3 years, then switch to an AI* 12% 12% 24% 38% 18% 22% AI + LHRH agonist or ovarian ablation 47% 9% 20% 42% 11% 16% Tamoxifen for 5 years, then no further treatment Tamoxifen for 5 years, then switch to an AI* Tamoxifen + LHRH agonist or ovarian ablation
  5. 5. What endocrine therapy, if any, would you recommend for a 35-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes ? * If patient becomes postmenopausal 2007 2006 2005 Practicing oncologists (PO) 7% 12% 8% Other 15% 6% 4% Tamoxifen for 2-3 years, then switch to an AI* 17% 18% 24% 19% 11% 6% AI + LHRH agonist or ovarian ablation 52% 10% 20% 37% 13% 21% Tamoxifen for 5 years, then no further treatment Tamoxifen for 5 years, then switch to an AI* Tamoxifen + LHRH agonist or ovarian ablation
  6. 6. What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative, node-negative tumor? * If patient becomes postmenopausal 7% 0% Other/no endocrine therapy Age 35, premenopausal 12% 12% 24% 52% 15% Tamoxifen + LHRH agonist or ovarian ablation 13% 29% 36% Tamoxifen for 2-3 years, then switch to an AI* Tamoxifen for 5 years, then switch to an AI* Tamoxifen for 5 years, then no further treatment Clinical investigators Practicing oncologists
  7. 7. What endocrine therapy, if any, would you recommend for a woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative, node-negative tumor? 7% 25% Tamoxifen for 2-3 years, then switch to an AI 5% 4% Other Age 55, postmenopausal 0% 20% 51% 5% Tamoxifen for 5 years, then switch to an AI 14% 69% Letrozole alone Anastrozole alone Clinical investigators Practicing oncologists
  8. 8. What endocrine therapy do you generally recommend for postmenopausal women with ER-positive, HER2-negative, node-negative tumors? 2007 2005 2002 Practicing oncologists (PO) 14% 3% 14% 69% 26% 58% Tamoxifen 0% 3% 39% 2% 0% 72% Exemestane Letrozole Anastrozole
  9. 9. When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI? 2007 2006 2005 Clinical investigators (CI) 4% 35% 61% 3% 11% 86% 3% 22% 75% Exemestane Letrozole Anastrozole
  10. 10. When you use an aromatase inhibitor (AI) as initial adjuvant therapy, what percent is with each AI? 2007 2006 2005 Practicing oncologists (PO) 6% 27% 67% 3% 11% 86% 6% 23% 71% Exemestane Letrozole Anastrozole
  11. 11. What percent of your patients on adjuvant AIs have significant arthralgias to the point that you consider discontinuing or switching agents ? 2007 2006 2005 9% 8% 5% Mean Practicing oncologists (PO) Clinical investigators (CI) 12% 10% 11% Mean
  12. 12. What action would you take initially when you consider discontinuing or switching agents with patients who have significant arthralgias? 10% 0% 8% 82% 4% Other 0% 20% 76% Discontinue hormonal therapy Switch to tamoxifen Switch to another AI Clinical investigators Practicing oncologists
  13. 13. What percent of your patients on adjuvant AIs have significant vasomotor symptoms to the point that you consider interventions such as SSRI antidepressants ? 2007 2006 2005 15% 19% 18% Mean Practicing oncologists (PO) Clinical investigators (CI) 16% 25% 23% Mean
  14. 14. What action would you take initially when you consider interventions with the patients who have significant vasomotor symptoms? 1% 11% Other 0% 0% 4% 85% 1% Discontinue hormonal therapy 4% 15% 79% Switch to tamoxifen Switch to another AI Continue therapy and add an SSRI Clinical investigators Practicing oncologists
  15. 15. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 1 year ago ? 2007 2006 2005 2% 5% 10% Use no further hormonal therapy 2% 2% 2% Start anastrozole 96% Clinical investigators (CI) 88% 93% Start letrozole
  16. 16. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 1 year ago ? 2007 2006 2005 18% 13% 24% Use no further hormonal therapy 20% 24% 12% Start anastrozole 62% Practicing oncologists (PO) 64% 63% Start letrozole
  17. 17. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 3 years ago ? 2007 2006 2005 29% 36% 80% Use no further hormonal therapy 0% 0% 0% Start anastrozole 71% Clinical investigators (CI) 20% 64% Start letrozole
  18. 18. What endocrine therapy, if any, would you recommend for a 65-year-old woman with a 1.2-cm, Grade II, ER-positive, PR-positive, HER2-negative tumor with 3 positive nodes who completed 5 years of tamoxifen 3 years ago ? 2007 2006 2005 58% 66% 76% Use no further hormonal therapy 12% 6% 6% Start anastrozole 30% Practicing oncologists (PO) 18% 28% Start letrozole
  19. 19. Which of the following best describes the action you would take in the following scenarios? A 60-year-old woman was treated 8 years ago at age 52 (postmenopausal) for an ER-positive, PR-positive, HER2-negative, node-negative tumor. She received tamoxifen for 5 years and now presents for routine follow-up, doing well after being off tamoxifen for 3 years. 8% 29% 10% 53% 1% Other 59% 11% 29% Not recommend any endocrine therapy and continue with follow-up Recommend an aromatase inhibitor Discuss the option of an aromatase inhibitor but state that this would not be your recommendation Clinical investigators Practicing oncologists
  20. 20. Which of the following best describes the action you would take in the following scenarios? A 60-year-old woman was treated 8 years ago at age 52 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/tamoxifen for 5 years and now presents for routine follow-up, doing well after being off tamoxifen for 3 years. 4% 6% 70% 20% 1% Other 47% 35% 17% Not recommend any endocrine therapy and continue with follow-up Recommend an aromatase inhibitor Discuss the option of an aromatase inhibitor but state that this would not be your recommendation Clinical investigators Practicing oncologists
  21. 21. Which of the following would you recommend in the following scenarios? A 61-year-old woman was treated 5 years ago at age 56 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/anastrozole for 5 years and has tolerated therapy without major difficulties. Clinical investigators Practicing oncologists 4% 14% Other 25% 0% 25% 36% 25% Explain that few data exist to support either continuing or discontinuing endocrine therapy and ask which option the patient would prefer 5% 22% 44% Switch to another AI Continue anastrozole Stop anastrozole and give no further endocrine treatment
  22. 22. Which of the following would you recommend in the following scenarios? An 81-year-old woman was treated 5 years ago at age 76 (postmenopausal) for an ER-positive, PR-positive, HER2-negative tumor with 4 positive nodes . She received chemotherapy/anastrozole for 5 years and has tolerated therapy without major difficulties. Clinical investigators Practicing oncologists 2% 4% Other 22% 0% 16% 58% 23% Explain that few data exist to support either continuing or discontinuing endocrine therapy and ask which option the patient would prefer 3% 15% 57% Switch to another AI Continue anastrozole Stop anastrozole and give no further endocrine treatment

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