Breast Cancer Update, Issue 2, 2016 (Video Program) - Video 18Management of everolimus-associated pneumonitis
1:50 minutes.
TRANSCRIPTION:
DR LOVE: So this case that we have that I wanted to run by you. Actually, it was from Dr Sara Tolaney from Dana-Farber, younger, 55-year-old postmenopausal woman, ER-positive, HER2-negative metastatic disease, multiple therapies and then gets exemestane/everolimus. And I’m curious, incidentally, right now are you using this combination? Where I’ve heard people talk about it is after palbo progression. DR DICKLER: Yes, I do use it in some cases. We have a nice array of clinical trials. So I’m always looking for genomic alteration based on next-gen sequencing and trying to match patients up with trials. But if that’s not possible, I do use exemestane and everolimus outside of a study in rare occasion. DR LOVE: So Dr Tolaney’s case: She was doing well on the everolimus and then found to have pulmonary infiltrates, was thought to have everolimus-related pneumonitis, really wasn’t very symptomatic, did have a little bit of cough, was put on corticosteroids. The cough went away; the infiltrates went away. And the question is, what do you do about her therapy, and, specifically, do you restart the everolimus and exemestane? I’ll tell you what the faculty said, but I’m curious what you would do in that situation. DR DICKLER: I guess it depends. Pneumonitis can range in severity, as you know. Some patients can get severely hypoxic, even require ICU admissions, whereas others it’s not as severe. I think you could potentially reinstitute the medicine at a lower dose, but I would be very wary of that. I would counsel the patient, because sometimes it can just manifest as a cough. And if she had any return of those symptoms, I would discontinue the medication. |