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Track 7

DR WOLFF: Was this patient in any type of breast cancer screening program after her treatment for Hodgkin disease?

DR MAVROTMATIS: She was not.

DR WOLFF: This is an important educational issue for cancer survivors, especially women who have received mantle irradiation. The risk of developing breast cancer is significantly increased, especially for those younger than age 20 receiving radiation therapy. It is high for those receiving radiation therapy between the ages of 20 and 30, and it is essentially nonexistent if she received her mantle irradiation when she was older than age 30. This is someone who should have been referred for screening (7.1).

DR LOVE: Skip, how would you think through this case, considering her history?

DR BURRIS: Everything about this case has a poor prognostic ring. I believe in the setting of prior radiation therapy, you’re certainly limited in considering it and would hope not to need to incorporate it.

I like the idea of noncross-resistant sequential therapy. For this patient I’d use four cycles of AC followed by four cycles of a taxane, either dose-dense or weekly paclitaxel.

DR MAVROTMATIS: Would she be eligible for ECOG-E5103 (7.2)?

DR WOLFF: She would be eligible because she has a tumor that is larger than one centimeter.

DR GRALOW: What about her history of Hodgkin disease?

DR WOLFF: I don’t recall. It may depend on the time since the diagnosis.

DR BURRIS: I believe enrolling her in one of the adjuvant bevacizumab trials is a great idea.

DR LOVE: What’s the design for ECOGE5103, Antonio?

DR WOLFF: It is a randomized trial of ACpaclitaxel with or without bevacizumab. It is a three-arm study with one arm as the control, one arm using six months of bevacizumab and the other arm using 12 months of bevacizumab. The trial includes patients with node-positive disease and also those with high-risk, node-negative disease. In ECOG-E5103, this patient would have a two-in-three chance of being randomly assigned to receive bevacizumab.

DR HUDIS: Doesn’t her prior mantle radiation therapy exclude her from enrollment?

DR FOX: I don’t know whether it disqualifies her, but I would venture to say this woman doesn’t have a normal myocardium.

DR LOVE: Would you stay away from an anthracycline?

DR FOX: I absolutely would.

DR LOVE: What would you consider using?

DR FOX: TC (docetaxel/cyclophosphamide; [Jones 2006]) would be our standard approach for someone with prior mantle radiation therapy.