Thread by @mjsikora

Clinical trials design for #lobular #breastcancer patients are finally available! Let's look for a moment at the Pitt Neoadjuvant Endocrine therapy trial.
lobularbreastcancer.org/clinical-trial…
#bcsm 1/

https://twitter.com/LobularBCA/status/1085607869716852737

In this trial, patients will be treated before surgery for 21 days with tamoxifen, anastrozole, or fulvestrant (all current drugs that target the estrogen receptor).

You might say, it's a short treatment without any new fancy drugs. What's important about this trial? 2/

The key thing about this trial is that it is DESIGNED and POWERED to answer a question specifically for #lobular. Similar trials have been done, both the short- and long-term settings, but trials all had few (if any) ILC, so no strong conclusions for #lobular could be made. 3/

For anti-estrogens, there are important questions that need answering. Perhaps the biggest is about tamoxifen - does Tam work for ILC patients? Clinical and laboratory data suggest that ILC have some form of tamoxifen-resistance, but we do not yet have definitive data. 4/

Unfortunately, it's just not feasible to do a brand new massive, 10-30-year trial looking at long-term outcomes for current standard-of-care in #lobular. 😠 That's where the pre-surgical ("neoadjuvant") trial comes in. 5/

Examining breast tumors before and after therapy in a short window (ie a few weeks, as in this trial) can be an excellent prediction of long-term therapy success or failure. So in this trial, we'll have the initial biopsy, three weeks of rx, then the removed tumor after rx. 6/

Comparing tumor biology before and after therapy for each drug (tamoxifen, anastrozole, and fulvestrant) will give us the best data to date on whether or not ILC respond better or worse to a specific anti-estrogen treatment. 7/

This data can guide how #lobular patients are treated in the adjuvant (post-surgical) setting, and ultimately - we hope - identify the best options for anti-estrogen therapy. 8/

SO - no fancy new drugs, but the Peo Neoadj endocrine therapy trial is our best chance to answer a CRITICAL question that has been a cloud hanging over the #lobular community for years. Spread the word!
lobularbreastcancer.org/clinical-trial…
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