2. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
79 yo F.
Single-lineage MDS: thrombocytopenia, transfusion-dependent diagnosed on
25/04/2017.
Recommendation:
Azacitidine
CBC tiw.
Platelet transfusion PRN
Reference
C920 (CALGB-9221: Azacytidine for MDS) Silverman, L.R., Demakos, E.P., Peterson, B.L., Kornblith, A.B.,
Holland, J.C., Odchimar-Reissig, R., Holland, J.F. (2002). Randomized Controlled Trial of Azacitidine in
Patients With the Myelodysplastic Syndrome: A Study of the Cancer and Leukemia Group B. Journal of
Clinical Oncology, 20 (10), 2429-2440. Https://doi.org/10.1200/JCO.2002.04.117
3. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
53 yo F.
Metastastic pancreatic adenocarcinoma to the lung, retroperitoneum and
liver, PS 1, without jaundice. Date of diagnosis: 04/17/2017, cT3 cN1 is
classified cM1 - Stage IV:
Recommendation
Palliative chemotherapy with FOLFIRINOX
Reference
C259 (PRODIGE - FOLFIRINOX in cancer of the metastatic pancreas). Conroy, T., Desseigne, F., Ychou, M.,
Bouché, O., Guimbaud, R., Bécouarn, Y., ... Ducreux, M. (2011). FOLFIRINOX versus Gemcitabine for
Metastatic Pancreatic Cancer. New England Journal of Medicine, 364 (19), 1817-1825.
Https://doi.org/10.1056/NEJMoa1011923
4. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
54 yo Female.
Pathogenic BRCA1 mutation (3459del4) established on 05/31/2007, confirming the
hereditary origin of her diseases (mother and 2 sisters with breast cancer, and a sister
with ovarian cancer.)
A history of triple-negative breast cancer in 1995 and contralateral triple-negative
breast cancer in 1997, both treated with surgery, chemotherapy, radiotherapy.
A Stage I fallopian tube carcinoma s/p oncologic resection in 2014. No adjuvant
chemotherapy was administered.
An unresectable stage ypIIIc high grade papillary serous carcinoma of the peritoneum
(laparoscopy on 04/20/2017).
Recommendation
Carboplatin + Paclitaxel followed by surgery
Reference
C56X (EORTC 55971 - Vergote, I., Tropé, CG, Amant, F., Kristensen, GB, Ehlen, T., Johnson, N., Reed, NS (2010)
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer, 10 (2). Retrieved from
http://www.nejm.org/doi/pdf/10.1056/NEJMoa0908806
5. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
55 yo Female.
A laparotomy was performed with an attachment hysterectomy for metastatic
adenocarcinoma of the ovary, with pancreatic lesion (in the tail of the pancreas, with
regional involvement), with R1 resection (distal pancreatectomy, splenectomy, partial
gastrectomy and splenic colectomy).
Immunohistochemistry is compatible with a primary pancreas and serous
cystadenocarcinoma of the ovary (Diagnosed on 03/29/2017).
Pancreatic adenocarcinoma classified as a pT3 cN1 cM1 - Stage IV, PS0:
Recommendation
Nab-paclitaxel + Gemcitabine until disease progression.
Reference
C259 (MPACT-Von Hoff, DD, Ervin, T., Arena, FP, Chiorean, EG, Infante, J., Moore, M., ... Renschler, MF (2013)
Increased Survival in Pancreatic Cancer with nab-Paclitaxel plus Gemcitabine, New England Journal of
Medicine, 369 (18), 1691-1703, https://doi.org/10.1056/NEJMoa1304369)
6. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
56 yo F.
A grade 2, luminal A, infiltrating ductal carcinoma of the breast, cT2 cN1(f) cM0 - Stage
IIB.
Neoadjuvant chemotherapy with AC (Doxorubicin + Cyclophosphamide). Started on
09/09/2016. Followed by weekly-paclitaxel ending on 2/17/2017.
BCS + ALND on 03/16/2017
Path: infiltrating ductal carcinoma with lobular pattern.
Luminal B (Ki67: 30%).
ypT1c (1.5 cm) ypN1a (3/15) - Stage IIB:
Recommendation
Adjuvant capecitabine (CREATE-X) with an AI after adjuvant RT.
Reference
Http://www.mdedge.com/oncologypractice/article/105067/breast-cancer/sabcs-create-x-capecitabine-
efficacious-against
7. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
40 yo F
8/27/2017: A grade 3, Her2+, HR- infiltrating ductal carcinoma
9/22/2016: Subcutaneous mastectomy + SNL (1/2 positive), followed by ALND
Path: 8 cm ductal carcinoma in situ + 2 cm infiltrating ductal carcinoma
TNM-Stage pT1c pN1MI cM0 - Stage IB.
10/28/2016: Begins adjuvant AC (Doxorubicin + Cyclophosphamide).
Complications: Several infections in the surgical site, requiring re-interventions, antibiotic therapy and
skin grafts.
05/05/2017: Finishes Paclitaxel + Trastuzumab on 05/05/2017:
Question
Can we forgo RT in this patient?
References
C509 (EBCTCG Post-mastectomy RT in N1 + early BC).
Early Breast Cancer Trialists' Collaborative Group), McGale, P., Taylor, C., Correa, C., Cutter, D., Duane, F., Darby, S.
(2014). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast
cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomized trials. The Lancet, 383
(9935), 2127-2135. Https://doi.org/10.1016/S0140-6736(14)60488-8
8. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
30 yo F.
01/19/2017: A luminal B, infiltrating ductal carcinoma of the breast.
TNM-Stage cT2 (2.1 cm) cN0(f) cM0 - Stage IIA.
02/12/2017: BCS + SNB.
Path: Grade 3 carcinoma, 2.3 cm, Her 2+ by FISH, 0 of 2 sentinel lymph nodes.
TNM-Stage cT2 (2.3 cm) cN0 (sn) cM0 - Stage IIA.
04/29/2017: Finished adjuvant RT.
Recommendation
Adjuvant Paclitaxel + Trastuzumab (without anthracyclines).
References
C509 (Adjuvant Paclitaxel + Trastuzumab in T1 / 2 (up to 3 cm) N0 M0, Her2 + BC). (Tolaney, SM, Barry,
WT, Dang, CT, Yardley, DA, Moy, B., Marcom, PK, ... Winer, EP (2015)) Adjuvant Paclitaxel and
Trastuzumab for Node-Negative, HER2-Positive Breast Cancer . England Journal of Medicine, 372 (2), 134-
141. Https://doi.org/10.1056/NEJMoa1406281
9. 1916 2006
1020
19961986
3040
19761966
5060
19561946
7080
19361926
90100
2016
68 yo M.
08/2014: High risk prostate cancer (group 5, PSA <10),
Radical prostatectomy (T2a N0 M0 - Gleason 5+4: 9, Estadío IIB),
03-04/2015: Adjuvant RT with ADT
Optimal PSA response.
05/2017: ADT x22mo.
Question: Must ADT be continued for 3 years?
Considerations
Adjuvant ADT for 2 or 3 years are acceptable options in high-risk prostate cancer
References
C61X (RTOG9202 - Long-term ADT (28 mo) + RT in High-risk / Locally-advanced Prostate Cancer. Horwitz EM, Bae K, Hanks
GE, et al. Ten-Year Follow-Up of Radiation Therapy Oncology Group Protocol 92-02: A Phase III Trial of the Duration of
Elective Androgen Deprivation in Locally Advanced Prostate Cancer. J Clin Oncol. 2008; 26 (15): 2497-2504. Doi: 10,200 /
JCO.2007.14.9021.
C61X(RTOG9408 - Short-term (4 mo) ADT superior to no ADT in RT-treated intermediate (but not low- or high-)-risk prostate
cancer) Jones CU, Hunt D, McGowan DG, et al. Radiotherapy and Short-Term Androgen Deprivation for Localized Prostate
Cancer. N Engl J Med. 2011;365(2):107-118. doi:10.1056/NEJMoa1012348.
