Access to oncology articles and MD only forums.
Hello,
To the moderator, MD associated witht this site, or anyone else who has access to the below two articles:
Synergistic Effect of Cell Kinetics-Directed Chemo-Endocrine Therapy on Experimental Mammary Tumors
https://link.springer.com/chapter/10.1007/978-1-4613-2049-4_37
The web site "theMednet.org" is accessible to only MD. It would be very helpful if an MD affiliated with "breastcancer.org" could access that site and post the complete answer to the question in the attached image.
Thanks so much!
Nguyen
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Nguyen,
These websites require a hefty monetary subscription paid for by hospitals, medical practices and academic institutions. This fee covers the constant updating and research required to keep the information organized and current. Individuals can pay for a single article (the first one is available for $30.) You could also ask a doctor who has this provided by an employer to consult a paper you are interested in but doing this would be a courtesy. While it might seem unfair it is how these companies stay in business. Try googling the key words to see if there is something on the topic that you can access for free. I hope you can find the information you are looking for.
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Hello Maggie15,
Thanks for your prompt respond! Yes sprinklerlink is expensive. "themednet.org" is free, but only MD can register (I tried) and participate.
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Hi nnguyen, Our editors do not have access to the Mednet. We're really sorry. Could you ask the medical oncologist or even ask their the portal. It would all depend on a number of factors, including the previous treatments received, so there will not be a one-size-fits all answer for us to provide, unfortunately. We're really sorry we can't help with this!
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Thank you for trying to help! I've done all that were suggested and more before posting on this forum. Regardless, reading the rest of the mednet posting is just for "dotting the I crossing the t" in my question of:
"What are the biological reasons and clinical evidence for/against concurrent cytotoxic and endocrine therapy?"
The recommendation from ASCO and NCI have been not to give them concurrently. The last few weeks I have done exhaustive research to know that that recommendation is questionable at least.
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I'll tell you what I heard from my MO and RO as well as my voracious journal reader perspective.
Due to a delay between my diagnosis and surgery (provoked blood clot in brachial and jugular veins in my right arm following bad needle stick with MRI) the MO put me on anastrozole prior to my surgery and chemo. I hadn't heard of this before, and came here to ask what I should think. The answer from trusted community members was that it was certainly not inferior treatment and it does seem there is benefit to this approach. I took this AI for about two months prior to eventually starting chemo.
I went off of it during chemo and didn't restart until finishing radiation. The reason the RO gave for waiting 'til after radiation is to avoid any confounding factors. If there were a side effect, it was helpful for her to know that the AI wasn't causing it. My instinctive thought on chemo was that if ever there were a time I wanted fast growing tumor cells to grow, it was while I had chemo knocking it out. I also know that so much of the treatment we get is based on standard protocols. It's what insurance expects, and what protects doctors from lawsuits. I complained about the depersonalization of treatment, but have come to realize that evidence based medicine doesn't move all that fast. For those of us with early breast cancer, I am confident that the treatments we get are as well tested and as evidence based as practical when considering recommendations to all clinicians in our country. Should there be studies to see if there is improvement in outcomes with starting endocrine therapy immediately? Maybe. Was I thrilled to find out before chemo and radiation that I'd be one with almost zero side effects from AI? Yes! Would I have been frustrated to be full of body aches or other side effects of AIs while dealing with every joy of chemo only to find it wasn't a well established benefit? Yes also.
The other fact is that something in a journal article or two isn't going to change treatments for all. And given what I know about replication of study results, that's okay with me at my stage.
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Hi nnguyen, To add to sarahmaude's information which deals with early stage breast cancer, if a situation is rare or the alternative is costly research isn't done or a protocol isn't developed. I have a rare side effect from radiation therapy for which two phase 1 clinical trials were proposed (in Mexico and China) but they never happened because they couldn't enroll enough participants. Also, oncologists could test for 4 different SNPs on chromosome 13 to identify the approximately 40% of patients who might have cartilage damage and consequent side effects on AIs. However, that would be way more expensive than having patients try the AIs and see what happens (per my MO.) When you are looking for something that isn't standard of care there is often no research done or protocol added for these two reasons.
One thing you could do is broaden your search to other types of cancer where this type of treatment might be more common. Esophageal or gastric cancer might be a good place to start. While it is not mbc any evidence there might shed some light on your questions or give a MO additional information to consider. The best of luck in any further investigations and treatment decisions.
P.S. I am following the proposed treatment in the RIPF trials that never happened since my pulmonologist thought that the proposal had merit and the treatment is relatively safe in his opinion.
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