Jennifer Plichta

Positions:

Assistant Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Depauw University

M.D. 2008

Indiana University School of Medicine

M.S. 2012

Loyola University Medical Center

General Surgery Resident, Surgery

Loyola University Medical Center

Breast Surgery Fellowship, Surgery

Brigham and Women's Hospital

Breast Surgery Fellowship, Surgery

Dana Farber Cancer Institute

Breast Surgery Fellowship, Surgery

Massachusetts General Hospital

Grants:

Genetic testing for women with high-risk breast lesions

Administered By
Surgical Oncology
Role
Principal Investigator
Start Date
End Date

Publications:

Nodal Response to Neoadjuvant Chemotherapy Predicts Receipt of Radiation Therapy after Breast Cancer Diagnosis.

BACKGROUND: Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is associated with improved overall survival (OS) in breast-cancer patients, but it is unclear how post-NACT response influences radiotherapy administration in patients presenting with node-positive disease. We sought to determine whether nodal pCR is associated with likelihood of receiving nodal radiation and whether radiotherapy among patients experiencing nodal pCR is associated with improved OS. METHODS: cN1 female breast cancer patients diagnosed 2010-2015 who were ypN0 (i.e., nodal pCR, n=12,341) or ypN1 (i.e., residual disease, n=13,668) post-NACT were identified in the National Cancer Database. Multivariate logistic regression was used to identify factors associated with receiving radiotherapy. Cox proportional hazards modeling was used to estimate the association between radiotherapy and adjusted OS. RESULTS: 26,009 patients were included. 43.9% (n=5,423) of ypN0 and 55.3% (n=7,556) of ypN1 patients received nodal radiation. Rates of nodal radiation remained the same over time among ypN0 patients (trend test p=0.29) but increased among ypN1 patients from 49% in 2010 to 59% in 2015 (trend test p<0.001). After adjusting for covariates, nodal pCR (vs no stage change) was associated with decreased likelihood of nodal radiation after mastectomy (∼20% decrease) and lumpectomy (∼30% decrease, both p<0.01). After mastectomy, nodal (vs no) radiation conferred no significant survival benefit in ypN0 patients but approached significance for ypN1 patients (hazard ratio [HR] 0.83, 95% CI 0.69-0.99, p=0.04, overall p-value=0.11). After lumpectomy, nodal radiation was associated with improved adjusted OS for ypN0 (HR 0.38, 95% CI 0.22-0.66) and ypN1 patients (HR 0.44, 95% CI 0.30-0.66, both p<0.001), but this improvement was not significantly greater than that associated with breast-only radiation. CONCLUSIONS: ypN0 patients were less likely to receive nodal radiation than ypN1 patients, suggesting that selective omission already occurs and, in the context of limited survival data, could potentially be appropriate for select patients.
MLA Citation
Fayanju, Oluwadamilola M., et al. “Nodal Response to Neoadjuvant Chemotherapy Predicts Receipt of Radiation Therapy after Breast Cancer Diagnosis..” Int J Radiat Oncol Biol Phys, Oct. 2019. Pubmed, doi:10.1016/j.ijrobp.2019.10.039.
URI
https://scholars.duke.edu/individual/pub1418091
PMID
31678225
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Published Date
DOI
10.1016/j.ijrobp.2019.10.039

Abstract P3-08-07: Distinct biological signatures describe differences in BRCA mutated subgroups

Authors
Force, J; Plichta, J; Stashko, I; Kimmick, G; Westbrook, K; Sammons, S; Hwang, S; Hyslop, T; Kauff, N; Castellar, E; Nair, S; Weinhold, K; Davis, S; Mashadi-Hossein, A; Brauer, HA; Marcom, PK
MLA Citation
Force, J., et al. “Abstract P3-08-07: Distinct biological signatures describe differences in BRCA mutated subgroups.” Poster Session Abstracts, American Association for Cancer Research, 2019. Crossref, doi:10.1158/1538-7445.sabcs18-p3-08-07.
URI
https://scholars.duke.edu/individual/pub1404158
Source
crossref
Published In
Poster Session Abstracts
Published Date
DOI
10.1158/1538-7445.sabcs18-p3-08-07

Clinical and pathological stage discordance among 433,514 breast cancer patients.

BACKGROUND: We aim to determine clinical and pathological stage discordance rates and to evaluate factors associated with discordance. METHODS: Adults with clinical stages I-III breast cancer were identified from the National Cancer Data Base. Concordance was defined as cTN = pTN (discordance: cTN≠pTN). Multivariate logistic regression was used to identify factors associated with discordance. RESULTS: Comparing clinical and pathological stage, 23.1% were downstaged and 8.7% were upstaged. After adjustment, factors associated with downstaging (vs concordance) included grade 3 (OR 10.56, vs grade 1) and HER2-negative (OR 3.79). Factors associated with upstaging (vs concordance) were grade 3 (OR 10.56, vs grade 1), HER2-negative (OR 1.25), and lobular histology (OR 2.47, vs ductal). ER-negative status was associated with stage concordance (vs downstaged or upstaged, OR 0.52 and 0.87). CONCLUSIONS: Among breast cancer patients, nearly one-third exhibit clinical-pathological stage discordance. This high likelihood of discordance is important to consider for counseling and treatment planning.
Authors
Plichta, JK; Thomas, SM; Sergesketter, AR; Greenup, RA; Fayanju, OM; Rosenberger, LH; Tamirisa, N; Hyslop, T; Hwang, ES
MLA Citation
Plichta, Jennifer K., et al. “Clinical and pathological stage discordance among 433,514 breast cancer patients..” Am J Surg, vol. 218, no. 4, Oct. 2019, pp. 669–76. Pubmed, doi:10.1016/j.amjsurg.2019.07.016.
URI
https://scholars.duke.edu/individual/pub1402270
PMID
31350005
Source
pubmed
Published In
Am J Surg
Volume
218
Published Date
Start Page
669
End Page
676
DOI
10.1016/j.amjsurg.2019.07.016

Ductal Carcinoma In Situ Management: All or Nothing, or Something in between?

© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Purpose of Review: Standard treatment for ductal carcinoma in situ (DCIS) is similar to that of invasive carcinoma. However, there is significant controversy regarding the true clinical implications of DCIS, and thus, the best management strategy. The aim of this review is to highlight relevant biology, diagnostic considerations, treatment options, and recent clinical trials. Recent Findings: Outcomes are generally excellent with low recurrence rates and exceptional disease-specific survival. Outcomes can be predicted using various prognostic indicators and/or nomograms to guide treatment decisions. Ongoing clinical trials of active surveillance are based upon the argument that ipsilateral invasive recurrence is the most clinically meaningful endpoint. These trials seek to compare ipsilateral invasive cancer diagnoses between standard of care and close monitoring. Summary: Recent trials have revealed the marked heterogeneity in the biology of DCIS, offering an opportunity to de-escalate therapy for women at lowest risk for progression. DCIS also presents an ideal setting in which to test novel prevention agents. Future care of patients with DCIS will include biomarker-based risk assessment in order to better individualize treatment to biologic risk of invasive progression.
Authors
MLA Citation
Plichta, J. K., et al. “Ductal Carcinoma In Situ Management: All or Nothing, or Something in between?.” Current Breast Cancer Reports, vol. 11, no. 3, Sept. 2019, pp. 190–202. Scopus, doi:10.1007/s12609-019-0306-2.
URI
https://scholars.duke.edu/individual/pub1402807
Source
scopus
Published In
Current Breast Cancer Reports
Volume
11
Published Date
Start Page
190
End Page
202
DOI
10.1007/s12609-019-0306-2

Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in Node-Positive Invasive Lobular Carcinoma.

BACKGROUND: Neoadjuvant chemotherapy (NACT) is often recommended for patients with node-positive invasive lobular carcinoma (ILC) despite unclear benefit in this largely hormone receptor-positive (HR+) group. We sought to compare overall survival (OS) between patients with node-positive ILC who received neoadjuvant endocrine therapy (NET) and those who received NACT. METHODS: Women with cT1-4c, cN1-3 HR+ ILC in the National Cancer Data Base (2004-2014) who underwent surgery following neoadjuvant therapy were identified. Kaplan-Meier curves and Cox proportional hazards modeling were used to estimate unadjusted and adjusted overall survival (OS), respectively. RESULTS: Of the 5942 patients in the cohort, 855 received NET and 5087 received NACT. NET recipients were older (70 vs. 54 years) and had more comorbidities (Charlson-Deyo score ≥ 1: 21.1% vs. 11.5%), lower cT classification (cT3-4: 44.2% vs. 51.0%), lower rates of mastectomy (72.5% vs. 82.2%), lower rates of pathologic complete response (0% vs. 2.5%), and lower rates of postlumpectomy (73.2% vs. 91.0%) and postmastectomy (60.0% vs. 80.8%) radiation versus NACT recipients (all p < 0.001). NACT recipients had higher unadjusted 10-year OS versus NET recipients (57.9% vs. 36.0%), but after adjustment, there was no significant difference in OS between the two groups (p = 0.10). CONCLUSIONS: Patients with node-positive ILC who received NET presented with smaller tumors, older age, and greater burden of comorbidities versus NACT recipients but had similar adjusted OS. While there is evidence from clinical trials supporting efficacy of NET in HR+ breast cancer, our findings suggest the need for further, histology-specific investigation regarding the optimal inclusion and sequence of endocrine therapy and chemotherapy in ILC.
MLA Citation
Thornton, M. J., et al. “Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in Node-Positive Invasive Lobular Carcinoma..” Ann Surg Oncol, vol. 26, no. 10, 2019, pp. 3166–77. Pubmed, doi:10.1245/s10434-019-07564-9.
URI
https://scholars.duke.edu/individual/pub1385787
PMID
31342392
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
26
Published Date
Start Page
3166
End Page
3177
DOI
10.1245/s10434-019-07564-9