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CML and Breast cancer

  • Irine Datikashvili-David
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5 months 1 week ago - 5 months 1 week ago #1957 by Irine Datikashvili-David
CML and Breast cancer was created by Irine Datikashvili-David
50 years old woman was diagnosed CML chronic phase in February 2024. BCR-ABL expression 40%. In History 2015 invasive ductal breast cancer  G2, ER +, PR+ , ki 67- 3-4%, HER2/neu -2+, Ki 67 3-4%, CISH negative. Radical mastectomy followed by radiotherapy and 2 month hormonotherapy have been performed. In 2022 Breast cancer relapse pT2NxM0, Ist A stage. Tampxiphen was given. In April 2024 3rd relapse- right breast invasive ductal carcinoma (G2), ER-80%, PR 50%, ki 67- 20%. Status post radical mastectomy pT1c (multi) N2 (MTS in 6 out of 14 lymph nodes). 

Since February 2024 the patient is given Imatinib Mesilate after 2 month treatme hematological response is confirmed( intially WBC count was 104 x109/l);  BCR -ABL expression was 20 %.

The patient needs aggressive chemotherapy for breast cancer. Planned chemotherapy drugs interact with imatinib .

What will be your consideration about continuation Imatinib or will it be more reasonable to stop Gliveec and check BCR once a month ?
Last edit: 5 months 1 week ago by arlene.
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  • Massimo Breccia
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5 months 1 week ago #1958 by Massimo Breccia
Replied by Massimo Breccia on topic CML and Breast cancer
We have treated some patients with CML and second neoplasia. During the chemotherapy we temporarily stopped TKI, considering that chemo probably acts also on the Ph+ stem cells. I suggest, if possible, to alternate TKI in the period between one cycle and another of chemo for breast cancer. It’s important to strictly monitor the molecular MRD.
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  • Ehab ATallah
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5 months 4 days ago #1959 by Ehab ATallah
Replied by Ehab ATallah on topic CML and Breast cancer
Would really depend on the chemotherapy planned. e.g
TKIs have been safely combined with HyperCVAD, so combining with AC for example would be safe.
There is a phase I of imatnib with taxol (Pishvaian MJ et al. A Phase I clinical trial of the combination of imatinib and paclitaxel in patients with advanced or metastatic solid tumors refractory to standard therapy. Cancer Chemother Pharmacol. 2012 Dec;70(6):843-53. doi: 10.1007/s00280-012-1969-9. Epub 2012 Sep 27. PMID: 23014737; PMCID: PMC3703247.)

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