Duke Cancer Network

After NACT, patients who presented with cN1 disease should still receive ALND if residual disease found in LNs, but if they have pCR, their survival=cN0 pts’. Some pearls from @DrLolaFayanju on surgical management of breast cancer @DukeCancer review. #bcsm #DCR2019

Dr. Blitzblau also notes there is accumulation evidence for once weekly and one week courses of radiation therapy for breast cancer as well as more data on safety of hypofractionated nodal treatment #DCR2019

...BUT, Dr. Blitzblau also notes that other schedules are available for individual pts - elderly, limited transportation, etc #DCR2019

Dr Blitzblau @ #DCR2019: ASTRO 2018 Consensus statement of HF-WBRT expanded indications: PREFERRED dose fractionation scheme is HFWBI to dose of 4000 cGY in 15 fractions or 4250 cGY in 16 fractions for women w/ invasive br ca receiving WBI w/wo inclusion of low axilla....

Dr Sarah Sammons notes top recent wins in breast cancer: 4. OS benefit for pre/perimenopausal women with ribociclib + endocrine Rx in 1st line ER+/HER2- advanced disease #DCR2019

Dr Sarah Sammons notes top recent wins in breast cancer: 3. T-DM1 in early stage HER2+ breast cancer with residual disease post Neoadj chemo #DCR2019

Dr Sarah Sammons notes top recent wins in breast cancer: 2. Alpelisib (with Fulvestrant) approved for advanced PIK3CA mutant ER+/HER2- disease #DCR2019

Dr Sarah Sammons notes top recent wins in breast cancer: 1. First immunotherapy combination approved for first-line treatment in advanced PDL-1+ TNBC with OS benefit #DCR2019

Dr Sarah Sammons notes that AI + Ovarian suppression and CDK4/6 inhibitor (ribociclib) should be 1st line SOC in pre/perimenopausal ER+/HER2- Advanced Br Ca #DCR2019

Hepatic artery infusion: may double survival for unresectable pts & convert unresectable pts to resectable; adjuvant HAI can result in 10yr survival rates >60% #DCR2019

Dr. Lidsky advises that resection of CRLM in the setting of compromised livers (steatosis, cirrhosis, etc) require large volume/function remnants. Strategies to assist include: parenchymal preservation; ablation/resection; 2 stage resections; portal vein embolization #DCR2019

Dr Michael Lidsky summarizes KEY DEFINITION of unresectable colorectal liver mets: R0 resection would require removal of all 3 hepatic veins, both portal veins, or retrohepatic IVC and/or leave <2 adequately perfused/drained hepatic segments #DCR2019

Dr. Hsu reviews TRIBE2 @ASCO 2019: Confirmed superiority of FOLFIRINOX bev to FOLFIRI bev in metastatic CRC #DCR2019

Dr. Hsu encourages awareness of the Neoadjuvant Rectal Score a la NRG-GI002 @ASCO2019, a composite score that reflects change in stage with treatment, providing more information about efficacy than pCR alone #DCR2019

Dr David Hsu notes @ASCO2019 The IDEA Collaboration, pooling results of 4 trials of ADJ Chemo (FOLFOX or CAPEOX), failed to demonstrate noninferiority of 3 mos vs 6 mos FOLFOX in high risk Stage II Colon CA #DCR2019

@ndevitomd: “In resected pancreatic cancer, adjuvant mFOLFIRINOX should be considered the standard of care when patients are able to tolerate this regimen #DCR2019

To avoid nontherapeutic laparotomy, the determination of resectability of pancreatic cancer demands appropriate pre-op assessments with high quality imaging and interpretation essential, according to Dr Allen. Should consider staging laparoscopy and peritoneal cytology #DCR2019

Duke Surgical Oncologist, Peter Allen notes that given the lack of high level (randomized) data to guide options, the treatment plan for pancreatic cancer should be tailored to individual patient and tumor characteristics #DCR2019

@arifkamalmd : Patients who enter hospice describe the transition as “falling off a cliff”... You do not have to let that happen; you CAN continue to see your patients who are on hospice. @DukeCancer @DukePallCare #DCR2019

Wonder how to have empathic conversations w/ pts? Try NURSE: name (the emotion), understand, respect, support, explore. @DukePallCare #DCR2019