Dr Adam Brufsky: Choosing a Therapy for Breast Cancer Patients

There are a number of treatment choices available to treat patients with breast cancer and diagnostic tests can assist in the decision making, according to Adam M. Brufsky, MD, PhD, co-director of the Comprehensive Breast Cancer Center at University of Pittsburgh.

How do you decide between chemotherapy, endocrine therapy, or targeted therapy for your patients? What role do diagnostic tests play in your treatment decisions?
The way I decide between chemotherapy and endocrine therapy really in early-stage breast cancer is number 1, using the estrogen receptor and number 2 I really think that a lot of use of multi parametric genomic tests, such as MammaPrint, Oncotype, EndoPredict, that sort of thing, to help us make clinical decisions as to whether someone should get chemotherapy or not based on their risk.

In late-stage breast cancer, it also is estrogen receptor positivity. It’s HER2 positivity. And I think that even as people get further along in their clinical course and have gone through multiple therapies a lot us are really starting to incorporate sematic DNA testing on these patients to try to find ESR, estrogen receptor, mutations. Potentially, HER2 tyrosine kinase mutations to help us figure out how to best treat these patients. Although those things are kind of experimental at this point, I think generally what I tend to use is estrogen receptor, HER2, how much disease the patient has, for example, I’ll decide between hormone therapy, receptor base, or HER2-base therapy in chemotherapy.
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