Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, co-director of the Comprehensive Breast Cancer, and associate director of clinical investigation at the University of Pittsburgh, discusses treatment options for male patients with breast cancer.

Men with breast cancer are treated similarly to postmenopausal women with the disease, Brufsky says. Androgen receptors (ARs) are likely to act as a tumor suppressor in this patient population, Brufsky adds. One upcoming trial will examine the use of an AR agonist in patients with estrogen receptor–positive, AR-positive metastatic breast cancer.

This research could impact the male patient population due to the potential role of ARs in male breast cancer, Brufsky says. Additionally, male patients tend to present with more advanced disease, namely stage II or higher; earlier-stage disease is uncommon, although cases are beginning to rise, Brufsky notes. 

A handful of treatment options are available for this population, including neoadjuvant and adjuvant chemotherapy, mastectomy, radiation, and tamoxifen. Aromatase inhibitors have also been considered for use, although some experts believe they may boost testosterone levels, which could either help or hinder the treatment of this patient population, Brufsky concludes.

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Adam M. Brufsky, MD, PhD, discusses treatment options for male patients with breast cancer.

Dr. Brufsky on Treatment Options for Male Breast Cancer

Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, co-director of the Comprehensive Breast Cancer, and associate director of clinical investigation at University of Pittsburgh, discusses the role of neoadjuvant chemotherapy in triple-negative breast cancer (TNBC).

It is important to consider whether neoadjuvant therapy should be used in this population, according to Brufsky. As most patients with TNBC will require chemotherapy at some point during their treatment, it is acceptable to treat them with this approach up front, according to Brufsky; this provides several benefits. For example, neoadjuvant chemotherapy can help shrink large tumors, lead to less extensive surgery, and allow more time to prepare for surgeries like mastectomy or reconstruction. Additionally, if a patient has a family history of disease, this also allows for time to test for 

 mutations and make surgical decisions accordingly.

Neoadjuvant therapy can also indicate whether the chemotherapy is effective in a patient, and can provide insight into whether another agent, such as capecitabine (Xeloda), is needed. Generally, neoadjuvant therapy is considered for tumors greater than 1 cm for patients with TNBC. Some practices will use this strategy for tumors that are 2 cm or T2, but neoadjuvant chemotherapy should be considered for tumors that are T1 and below, Brufsky concludes.

Adam M. Brufsky, MD, PhD, discusses the role of neoadjuvant chemotherapy in triple-negative breast cancer.

Dr. Brufsky on the Role of Neoadjuvant Chemotherapy in TNBC

Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, and co-director of Comprehensive Breast Cancer Center at the University of Pittsburgh School of Medicine, discusses the treatment of early-stage, HER2-positive breast cancer.

Generally, patients with early-stage, metastatic HER2-positive breast cancer are treated depending on the size of their tumor, says Brufsky. If the tumor is greater than 2 cm, patients will receive neoadjuvant chemotherapy, usually with trastuzumab (Herceptin) and pertuzumab (Perjeta). If the patient achieves a pathologic complete response, they will then receive trastuzumab or pertuzumab for 1 year; if they do not, they will receive ado-trastuzumab emtansine (T-DM1; Kadcyla).

For patients with tumors of less than 1 cm, they will undergo surgery and then a decision will be made on next steps. If they have tumors that are less than 2 cm and are node negative, they will likely receive adjuvant paclitaxel and trastuzumab for 12 cycles or 12 weeks. Some will give T-DM1 for 1 year, but that decision is a little controversial right now, concludes Brufsky.

Adam M. Brufsky, MD, PhD, discusses the treatment of early-stage, HER2-positive breast cancer.

Adam Brufsky,MD

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