NEOADJUVANT THERAPY FOR BREAST CANCER: LOCAL EXPERT OPINION AND RECENT EVIDENCE
|
|
- Christiana Franklin
- 5 years ago
- Views:
Transcription
1 NEOADJUVANT THERAPY FOR BREAST CANCER: LOCAL EXPERT OPINION AND RECENT EVIDENCE Dr. Joanne Chiu Medical Oncology Queen Mary Hospital The University of Hong Kong
2 HONG KONG SURVEY FOR NEOADJUVANT THERAPY IN BREAST CANCER The treatment of breast cancer has revolutionized in the past ten years Statistics demonstrate an increasing adaptation of pre-operative therapy for localized breast cancer A survey was conducted amongst local high-volume centres and doctors as a fact finding exercise on local practice in neoadjuvant therapy for breast cancer 1. Patient selection 2. Logistic 3. Choice of neoadjuvant therapy 4. Post treatment issue: pcr intrepretation, IHC status, LN management
3 Number HONG KONG SURVEY RESULTS respondents (55% responded) Breakdown by specialty: oncologists (73 invited) surgeons (36 invited) 40 4 pathologist (11 invited) 1 radiologist (7 invited) Invited Responded Breakdown by setting: 34 in public hospitals 20 in private clinics 10 0 Oncologists Surgeons Pathologists Radiologists 11 in private hospitals Specialty Majority of respondents noticed an increase trend in use of neoadjuvant therapy in the last 5 years, and they considered the neoadjuvant therapy to be a standard of care
4 PATIENT SELECTION WOULD YOU RECOMMEND NEOADJUVANT THERAPY FOR LOCALLY ADVANCED (T>2 AND N<1) BUT STILL OPERABLE BREAST CANCER? 3% 8% Agreed that neoadjuvant therapy should be considered for downsizing in operable breast cancer patients who wants BCT 89%
5 DO YOU HAVE AN UPPER-AGE LIMIT FOR RECOMMENDING NEOADJUVANT THERAPY? 8% 54% 38% Biological age, and the presence of comorbidities would probably be more important consideration than actual age for offering neoadjuvant therapy Choice of neoadjuvant therapy is subtype-dependent Some regimens can be chemotherapy-free Neoadjuvant therapy is very effective in certain subtypes of breast cancer.
6 LOGISTIC DO YOU PRACTICE IN AN INSTITUTION WITH A DEDICATED BREAST CANCER MULTIDISCIPLINARY TEAM (MDT)? 32% 68% MDT plays a crucial role in the management of early breast cancer. It is the current gold standard of management as recommended by various guidelines 1, NICE guidline, updated 2017 Public: 100% Private: 39% Many private doctors have solo practice Coordination of MDT requires dedicated leaders & concerted commitment of all team members Private doctors might not have enough patient volume for a particular cancer to justify MDT
7 IS THERE A DEDICATED CASE MANAGER RESPONSIBLE FOR THE COORDINATION OF NEOADJUVANT CHEMOTHERAPY FOR TIMELY TREATMENT AND SUBSEQUENT ASSESSMENT TO ENABLE A SMOOTH PATIENT JOURNEY IN THIS COMPLEX LOGISTICAL TREATMENT PARADIGM? Role of case manager has been defined: Liaise for and follow the progress of the patient from diagnosis to surgery 43% 57% Public: 97% Private: 19% Under HA COC cancer, each breast cancer patient is required to have a case manager.
8 DO YOU ROUTINELY DISCUSS THE USE OF NEOADJUVANT THERAPY IN MDT MEETINGS BEFORE THE COMMENCEMENT OF THERAPY? Oversea experience and recommendation: 35% 8% 57% Public: 70% Private: 43% Retrospective studies suggested implementation of MDT was associated with better patient survival 1,2 Regional guidelines to govern the structure and running of MDTs has been suggested by international guideline 3 Encourage interdisciplinary team discussion wherever possible, or liaise with centers with MDT board Although an MDT is available, only selected cases are discussed before the commencement of neoadjuvant therapy The effectiveness, expertise, and actual utilization of MDT in each center remained unclear 1. Eaker et al., Cancer Epidemiol biomarkers Prev, 2005; 2. Kesson et l., BMJ, 2012; 3. NICE guidline 2002
9 WHAT IS THE PREFERRED METHOD FOR STAGING BEFORE STARTING NEOADJUVANT THERAPY? % 58% Expert preference: PET-CT/MRI is the preferred method of staging, yet not included in most guidelines Good specificity in axilla evaluation Better than CT in detection of N3 disease and distant metastasis Systemic imaging should be encouraged in all node-positive disease CT is acceptable if patients cannot afford PET
10 IS THE INSERTION OF A METALLIC MARKER IN THE TUMOUR BED BEFORE STARTING NEOADJUVANT THERAPY A ROUTINE PRACTICE IN YOUR INSTITUTION? 44% 10% 46% Marker insertion prior to commencement of neoadjuvant therapy should be a standard practice => put forward in specialty surgical forum Omission of marker in patients receiving neoadjuvant chemotherapy and BCT was associated with increased local recurrence 1,2 Marker insertion, even for planned mastectomy can facility pathological evaluation 1. Oh et al., Cancer, 2007; 2. Dash et al., AJR Am J Roentgenol, 1999
11 CHOICE OF NEOADJUVANT THERAPY
12 HER2-positive breast cancer FOR HER2+ BREAST CANCER PATIENTS BEING OFFERED NEOADJUVANT THERAPY, IS DUAL BLOCKADE WITH TWO ANTI-HER2 AGENTS AN APPROACH YOU CONSIDER PART OF YOUR PRACTICE? 21% 11% 68% Double anti-her2 blockade should be offered where possible NeoSphere: Trastuzumab + pertuzumab with chemotherapy increased pcr which translated into reduction in recurrence 1 1. Gianni etla., Lancet Oncol, 2016
13 DO YOU CONSIDER ANTHRACYCLINES AN ESSENTIAL COMPONENT OF THE CHEMOTHERAPY BACKBONE IN TREATMENT OF HER2 + BREAST CANCER IN THE NEOADJUVANT SETTING? 22% 54% 24% Perhaps with the great response rate of modern double anti-her2 regimen, the use of anthracycline should be diminished BCIRG006 1 : high risk HER2-positive patients given AC + TH c/w DCH had 5x CHF and increased leukemia APHINITY 2 and NeoSphere 3 improved survival and pcr with adding pertuzumab The role of anthracycline is unclear for patients with resistant or residual disease 1. Slamon et al., Cancer Res, Von Minckwitz et al., NEJM, Gianni etla., Lancet Oncol, 2016
14 Hormone-receptor positive HER2-negative breast cancer FOR POST MENOPAUSAL HR+ HER2 BREAST CANCER PATIENTS, IS NEOADJUVANT THERAPY WITH AN AROMATASE INHIBITOR (AI) A POSSIBLE RECOMMENDATION FOR YOU? 10% 3% Neoadjuvant AI in post-menopausal women with luminal A disease is a well accepted option St. Gallen consensus: favors de-escalation from chemotherapy 1 87% Genomic testing can provide guidance on patients who don t derive additional benefit with chemotherapy Early data for node-positive disease Enrolling into clinical trial is an acceptable option 1. Gnant et al., Breast Care, 2017
15 Triple negative breast cancer FOR PATIENTS WITH TRIPLE-NEGATIVE BREAST CANCER RECEIVING NEOADJUVANT THERAPY, WOULD YOU ROUTINELY INCORPORATE PLATINUM SALTS, SUCH AS CISPLATIN OR CARBOPLATIN, INTO THE REGIMEN? consensus can be reached 21% Some evidence to suggest use of carboplatin is associated with modest increase in pcr but more toxicity 44% Use in BRCA+ disease: inadequate data 35%
16 WOULD YOU CONSIDER TESTING FOR BRCA MUTATIONS OR OTHER INHERITABLE GENETIC PREDISPOSITIONS TO BREAST CANCER FOR TRIPLE-NEGATIVE BREAST CANCER PATIENTS DURING NEOADJUVANT THERAPY? BRCA status can provide guidance on choice of surgery 24% Turnaround time limits how it can impact decision making 41% 35%
17 Pathological outcome WOULD YOU AGREE WITH THE STATEMENT PATHOLOGICAL COMPLETE RESPONSE (PCR) AT SURGERY IS PROGNOSTIC OF EVENTUAL CLINICAL OUTCOME FOR A SUBGROUP OF BREAST CANCER PATIENTS UNDERGOING NEOADJUVANT THERAPY? 1% 2% 97% HR+/HER2 - HER+/HER2+ HR-/HER2+ TNBC
18 FOR PATIENTS WITH RESIDUAL INVASIVE CANCER AFTER NAC, IS ER/PR AND HER2 IMMUNOHISTOCHEMISTRY (IHC) PERFORMED ROUTINELY? 18% 82% IHC on residual invasive cancer should be done routinely It can affect management Most respondents had experience with change in subtype in residual tumor 23% 5% 13% 59% Less than 5% of the time 5-10% of the time 10-30% of the time More than 30% of the time
19 Sentinel lymph node WOULD YOU CONSIDER PERFORMING SENTINEL NODE BIOPSY FOR PATIENTS AFTER NAC IF THEIR PRETREATMENT NODAL STATUS IS NEGATIVE? 14% 3% It is a standard practice 1,2 83% 1. NCCN guideline Lyman, JCO, 2015
20 WOULD YOU CONSIDER PERFORMING SENTINEL NODE BIOPSY FOR PATIENTS AFTER NAC IF THEIR PRETREATMENT NODAL STATUS IS POSITIVE BUT THEIR POST-NAC PET SCAN SHOWED METABOLIC QUIESCENCE (CN1/2 => CN0)? 43% 8% 49% Management in such situation is still controversial 1 San Gallen consensus 2 : SNB is the gold standard with negative axillary staging after neoadj therapy; while axillary clearance is still recommended with at least 1 metastatic node found Patients with limited SLN+, SLND or ALND had similar surival 3 Role of adjuvant RT in this case? 1. Corso et al., Future Med, Gnant et al., Breast Care, Giuliano et al., JAMA, 2017
21 SUMMARY Neoadjuvant therapy for early breast cancer is a standard of care, and should be considered for patient being considered for BCT MDT plays a crucial role in the management in these patients Systemic imaging should be done in all LN+ disease Choice of neoadjuvant regimen: Double anti-her2 with pertuzumab/trastuzumab Hormonal therapy for post-menopausal luminal A Role of platinum in TNBC still controversial IHC for residual disease should be performed routinely SLN post-neoadjuvant therapy is a gold standard. Who should get ALND / adj RT is still controversial
22 Acknowledgment Dr. CHAN Keeng Wai Dr. Polly CHEUNG Dr. Joanne CHIU Dr. Carol KWOK Dr. Ava KWONG Dr. Roland LEUNG Dr. Lawrence LI Dr. NG Ting Ying Prof. Roger NGAN Dr. Inda SOONG Dr. SUEN To Ki Dacita Dr. WONG Ting Ting Dr. Thomas YAU Prof. Winnie YEO May Lee
EARLY BREAST CANCER, HER2-POSITIVE
EARLY BREAST CANCER, HER2-POSITIVE CLINICAL CASE DISCUSSION Elżbieta Senkus Medical University of Gdańsk Gdańsk, Poland esmo.org DISCLOSURES Honoraria: Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene,
More informationNeoadjuvant therapy a new pathway to registration?
Neoadjuvant therapy a new pathway to registration? Graham Ross, FFPM Clinical Science Leader Roche Products Ltd Welwyn Garden City, UK (full time employee) Themes Neoadjuvant therapy Pathological Complete
More informationUpdates on management of the axilla in breast cancer the surgical point of view
Updates on management of the axilla in breast cancer the surgical point of view Edwige Bourstyn Centre des maladies du sein Hôpital Saint Louis Paris Sentinel lymph node biopsy (SLNB) is the standard of
More informationTriple Negative Breast cancer New treatment options arenowhere?
Triple Negative Breast cancer New treatment options arenowhere? Ofer Rotem, M.D., B.Sc. Breast Unit, Davidoff center Rabin Medical center October 2017 Case 6/2013 - M.D., 38 years old woman, healthy, no
More informationObjectives Critically review presentations on 1. Local therapy 2. Adjuvant chemotherapy for isolated local regional recurrence 3. The optimal duration
Objectives Critically review presentations on 1. Local therapy 2. Adjuvant chemotherapy for isolated local regional recurrence 3. The optimal duration of endocrine therapy 4. Advances in HER2 directed
More informationUpdate on New Perspectives in Endocrine-Sensitive Breast Cancer. James R. Waisman, MD
Update on New Perspectives in Endocrine-Sensitive Breast Cancer James R. Waisman, MD Nothing to disclose DISCLOSURE TAILORx Oncotype Recurrence Score TAILORx Study Design Sparano, J Clin Oncol 2008;26:721-728
More informationPrinciples of breast radiation therapy
ANZ 1601/BIG 16-02 EXPERT ESMO Preceptorship Program 2017 Principles of breast radiation therapy Boon H Chua Professor Director of Cancer and Haematology Services UNSW Sydney and Prince of Wales Hospital
More informationEvaluation of Pathologic Response in Breast Cancer Treated with Primary Systemic Therapy
Evaluation of Pathologic Response in Breast Cancer Treated with Primary Systemic Therapy Eun Yoon Cho, MD, PhD Department of Pathology and Translational Genomics Samsung Medical Center Sungkyunkwan University
More informationNeoadjuvant Treatment of. of Radiotherapy
Neoadjuvant Treatment of Breast Cancer: Role of Radiotherapy Neoadjuvant Chemotherapy Many new questions for radiation oncology? lack of path stage to guide indications should treatment response affect
More informationEvolution of Breast Surgery
Evolution of Breast Surgery Natasha Rueth MD Surgical Oncologist Piper Breast Center and Alina Health Surgical Specialists Minneapolis, MN Definitions Radical Mastectomy: Removal of breast, chest muscles,
More informationFeasibility of Preoperative Axillary Lymph Node Marking with a Clip in Breast Cancer Patients before Neoadjuvant Chemotherapy: A Preliminary Study
[ABS-0078] GBCC 2018 Feasibility of Preoperative Axillary Lymph Node Marking with a Clip in Breast Cancer Patients before Neoadjuvant Chemotherapy: A Preliminary Study Eun Young Kim 1, Kwan Ho Lee 1, Yong
More informationRecent Update in Surgery for the Management of Breast Cancer
Recent Update in Surgery for the Management of Breast Cancer Wonshik Han, MD, PhD Professor, Department of Surgery, Seoul National University College of Medicine Chief of Breast Care Center, Seoul National
More informationPost-Mastectomy RT after Neoadjuvant Chemotherapy (NAC)
Post-Mastectomy RT after Neoadjuvant Chemotherapy (NAC) Jay R. Harris, M.D. Dana-Farber Cancer Institute Brigham and Women s Hospital Harvard Medical School Conclusions When considering PMRT, use both
More informationEARLY STAGE BREAST CANCER ADJUVANT CHEMOTHERAPY. Dr. Carlos Garbino
EARLY STAGE BREAST CANCER ADJUVANT CHEMOTHERAPY Dr. Carlos Garbino EARLY BREAST CANCER ADJUVANT CHEMOTHERAPY SUSTANTIVE DIFFICULTIES FOR A WORLDWIDE APPLICABILITY DUE TO IMPORTANT INEQUALITIES + IN DIFFERENT
More informationHER2-Targeted Rx. An Historical Perspective
HER2-Targeted Rx An Historical Perspective Trastuzumab: Front Line Rx for MBC Median 20.3 v. 25.1 mo P = 0.046 HR 0.8 65% of control patients crossed over Slamon D, et al. N Engl J Med, 2001; 344:783 Trastuzumab:Front-line
More informationBreast Cancer Earlier Disease. Stefan Aebi Luzerner Kantonsspital
Breast Cancer Earlier Disease Stefan Aebi Luzerner Kantonsspital stefan.aebi@onkologie.ch Switzerland Breast Cancer Earlier Disease Diagnosis and Prognosis Local Therapy Surgery Radiation therapy Adjuvant
More informationInvasive Breast Cancer
Invasive Breast Cancer Eileen Rakovitch MD MSc FRCPC Sunnybrook Health Sciences Centre Medical Director, Louise Temerty Breast Cancer Centre LC Campbell Chair in Breast Cancer Research Associate Professor,
More informationLocally Advanced Breast Cancer: Systemic and Local Therapy
Locally Advanced Breast Cancer: Systemic and Local Therapy Joseph A. Sparano, MD Professor of Medicine & Women s Health Albert Einstein College of Medicine Associate Chairman, Department of Oncology Montefiore
More informationImpact of BMI on pathologic complete response (pcr) following neo adjuvant chemotherapy (NAC) for locally advanced breast cancer
Impact of BMI on pathologic complete response (pcr) following neo adjuvant chemotherapy (NAC) for locally advanced breast cancer Rachna Raman, MD, MS Fellow physician University of Iowa hospitals and clinics
More informationNeoadjuvant chemotherapy (NACT) in young women with breast cancer. Hanne Melgaard Nielsen, MD Ph.D Department of Oncology, Aarhus University Hospital
Neoadjuvant chemotherapy (NACT) in young women with breast cancer Hanne Melgaard Nielsen, MD Ph.D Department of Oncology, Aarhus University Hospital Young women according to EUSOMA guidelines Is under
More informationIdeal neo-adjuvant Chemotherapy in breast ca. Dr Khanyile Department of Medical Oncology, University of Pretoria
Ideal neo-adjuvant Chemotherapy in breast ca Dr Khanyile Department of Medical Oncology, University of Pretoria When is neo-adjuvant Chemo required? Locally advanced breast ca: - Breast conservative surgery
More informationBreast cancer treatment
Report from the San Antonio Breast Cancer Symposium Breast cancer treatment Determining the best options for select patient groups Sara Soldera, MD, Resident; Nathaniel Bouganim, MD, FRCPC, Medical Oncologist;
More informationPMRT for N1 breast cancer :CONS. Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center
PMRT for N1 breast cancer :CONS Won Park, M.D., Ph.D Department of Radiation Oncology Samsung Medical Center DBCG 82 b & c Overgaard et al Radiot Oncol 2007 1152 pln(+), 8 or more nodes removed Systemic
More informationThe Role of Sentinel Lymph Node Biopsy and Axillary Dissection
The Role of Sentinel Lymph Node Biopsy and Axillary Dissection Henry Mark Kuerer, MD, PhD, FACS Department of Surgical Oncology University of Texas MD Anderson Cancer Center SLN Biopsy Revolutionized surgical
More informationPage 1. AHN-JHU Breast Cancer Symposium. Novel Local Regional Clinical Trials. Background. Neoadjuvant Chemotherapy Benefit.
AHN-JHU Breast Cancer Symposium Novel Local Regional Clinical Trials March 22, 2019 Thomas B. Julian, MD, FACS Associate Medical Director, Cancer Program Development, ANH Cancer Institute Background In
More informationThe Role of Pathologic Complete Response (pcr) as a Surrogate Marker for Outcomes in Breast Cancer: Where Are We Now?
1 The Role of Pathologic Complete Response (pcr) as a Surrogate Marker for Outcomes in Breast Cancer: Where Are We Now? Terry Mamounas, M.D., M.P.H., F.A.C.S. Medical Director, Comprehensive Breast Program
More informationDebate Axillary dissection - con. Prof. Dr. Rodica Anghel Institute of Oncology Bucharest
Debate Axillary dissection - con Prof. Dr. Rodica Anghel Institute of Oncology Bucharest Summer School of Oncology, third edition Updated Oncology 2015: State of the Art News & Challenging Topics Bucharest,
More informationReview of adjuvant and neo-adjuvant abstracts from SABCS 2011 January 7 th 2012
Review of adjuvant and neo-adjuvant abstracts from SABCS 2011 January 7 th 2012 Ruth M. O Regan, MD Professor and Vice-Chair for Educational Affairs, Department of Hematology and Medical Oncology, Emory
More informationRadiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy. Julia White MD Professor, Radiation Oncology
Radiotherapy Management of Breast Cancer Treated with Neoadjuvant Chemotherapy Julia White MD Professor, Radiation Oncology Agenda Efficacy of radiotherapy in the management of breast cancer in the Adjuvant
More informationNeoadjuvant (Primary) Systemic Therapy
Diagnosis and Treatment of Patients with Primary and Metastatic reast Cancer Neoadjuvant (Primary) Systemic Therapy Neoadjuvant Systemic Therapy Versions 2002 2017: auerfeind / lohmer / Costa / Dall /
More informationControversies in Breast Pathology ELENA PROVENZANO ADDENBROOKES HOSPITAL, CAMBRIDGE
Controversies in Breast Pathology ELENA PROVENZANO ADDENBROOKES HOSPITAL, CAMBRIDGE Neoadjuvant Chemotherapy Indications: Management of locally advanced invasive breast cancers including inflammatory breast
More informationResults of the ACOSOG Z0011 Trial
DCIS and Early Breast Cancer Symposium JUNE 15-17 2012 CAPPADOCIA Results of the ACOSOG Z0011 Trial Kelly K. Hunt, M.D. Professor of Surgery Axillary Node Dissection Staging, Regional control, Survival
More informationPosition Statement on Management of the Axilla in Patients with Invasive Breast Cancer
- Official Statement - Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the
More informationImplications of ACOSOG Z11 for Clinical Practice: Surgical Perspective
:$;7)#*8'-87*4BCD'E7)F'31$4.$&'G$H'E7)F&'GE'>??ID >?,"'@4,$)4*,#74*8'!74/)$++'74',"$'A.,.)$'7%'()$*+,'!*42$)!7)74*67&'!3 6 August 2011 Implications of ACOSOG Z11 for Clinical
More informatione-session 381 BCY3 - Highlights of the 3rd ESO-ESMO Breast Cancer in Young Women International Conference
Expert: Dr Olivia Pagani, Oncology Institute of Southern Switzerland, Lugano, Switzerland Discussant: Dr Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy e-session 381 BCY3 - Highlights
More informationA case of a BRCA2-mutated ER+/HER2 breast cancer during pregnancy
ESMO Preceptorship Programme Breast Cancer Lisbon 16,17 September 2016 Emanuela Risi Sandro Pitigliani Medical Oncology Department Hospital of Prato, Istituto Toscano Tumori, Prato, Italy A case of a BRCA2-mutated
More informationSt Gallen 2017 controversies & consensus
St Gallen 2017 controversies & consensus Shani Paluch-Shimon, MBBS, MSc Head, Breast Cancer Service for Young Women Breast Unit, Division of Oncology Sheba Medical Centre June 2017 St Gallen 2017 De-escalation
More informationNational Breast Cancer Audit next steps. Martin Lee
National Breast Cancer Audit next steps Martin Lee National Cancer Audits Current Bowel Cancer Head & Neck Cancer Lung cancer Oesophagogastric cancer New Prostate Cancer - undergoing procurement Breast
More information16/09/2015. ACOSOG Z011 changing practice. Presentation outline. Nodal mets #1 prognostic tool. Less surgery no change in oncologic outcomes
ACOSOG Z011 changing practice The end of axillary US/FNA? Preoperative staging of the axilla in the era of Z011 Adena S Scheer MD MSc FRCSC Surgical Oncologist, St. Michael s Hospital Assistant Professor,
More informationBreast Imaging: Multidisciplinary Approach. Madelene Lewis, MD Assistant Professor Associate Program Director Medical University of South Carolina
Breast Imaging: Multidisciplinary Approach Madelene Lewis, MD Assistant Professor Associate Program Director Medical University of South Carolina No Disclosures Objectives Discuss a multidisciplinary breast
More informationBreast Cancer. Most common cancer among women in the US. 2nd leading cause of death in women. Mortality rates though have declined
Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women Mortality rates though have declined 1 in 8 women will develop breast cancer Breast Cancer Breast cancer increases
More informationContemporary Classification of Breast Cancer
Contemporary Classification of Breast Cancer Laura C. Collins, M.D. Vice Chair of Anatomic Pathology Professor of Pathology Beth Israel Deaconess Medical Center and Harvard Medical School Boston, MA Outline
More informationBreast Cancer. Saima Saeed MD
Breast Cancer Saima Saeed MD Breast Cancer Most common cancer among women in the US 2nd leading cause of death in women 1 in 8 women will develop breast cancer Incidence/mortality rates have declined Breast
More informationMaria João Cardoso, MD, PhD
Locally Advanced Breast Cancer Specific Issues in LocorregionalTreatment Surgery, MD, PhD Head Breast Surgeon Breast Unit, Champalimaud Foundation Lisbon, Portugal 1 Conflict of Interest Disclosure No
More informationPRO: Pathologic Complete Response Does Predict Outcome for Early Stage Breast Cancer Patients
PRO: Pathologic Complete Response Does Predict Outcome for Early Stage Breast Cancer Patients Amelia B. Zelnak, M.D., M.Sc. Assistant Professor of Hematology and Medical Oncology Winship Cancer Institute
More informationBreast Cancer Breast Managed Clinical Network
Initial Evaluation Clinical Stage Pre-Treatment Evaluation Treatment and pathological stage Less than 4 positive lymph nodes Adjuvant Treatment ER Positive HER2 Negative (see page 2 & 3 ) HER2 Positive
More informationEvaluating the Z011 study and how local-regional therapy for early breast cancer may change
Evaluating the Z011 study and how local-regional therapy for early breast cancer may change Karen Hoffman, M.D., M.H.Sc., M.P.H. Dept of Radiation Oncology The University of Texas MD Anderson Cancer Center
More informationXII Michelangelo Foundation Seminar
XII Michelangelo Foundation Seminar Paradigm shift? The Food and Drug Administration collaborative project P. Cortazar, Silver Spring, USA FDA Perspective: Moving from Adjuvant to Neoadjuvant Trials in
More informationBiomarkers for HER2-directed Therapies : Past Failures and Future Perspectives
Biomarkers for HER2-directed Therapies : Past Failures and Future Perspectives Ian Krop Dana-Farber Cancer Institute Harvard Medical School Inchon 2018 Adjuvant Trastuzumab Improves Outcomes in HER2+ Breast
More informationImplications of ACOSOG Z11 for Clinical Practice: Surgical Perspective
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA 6 August 2011 Implications of ACOSOG Z11 for Clinical
More informationTargeting Surgery for Known Axillary Disease. Abigail Caudle, MD Henry Kuerer, MD PhD Dept. Surgical Oncology MD Anderson Cancer Center
Targeting Surgery for Known Axillary Disease Abigail Caudle, MD Henry Kuerer, MD PhD Dept. Surgical Oncology MD Anderson Cancer Center Nodal Ultrasound at Diagnosis Whole breast and draining lymphatic
More informationBreast Cancer: Management of the Axilla in Greg McKinnon MD FRCSC SON Vancouver Oct 2016
Breast Cancer: Management of the Axilla in 2016 Greg McKinnon MD FRCSC SON Vancouver Oct 2016 No Disclosures Principle #1 There is no point talking about surgical therapy in isolation. From a patient
More informationSystemic Therapy for Locally Advanced Breast Cancer
Systemic Therapy for Locally Advanced Breast Cancer Soo-Chin Lee Head & Senior Consultant Department of Haematology-Oncology National University Cancer Institute, Singapore Clinical Care Senior Principal
More informationBreast Cancer. Dr. Andres Wiernik 2017
Breast Cancer Dr. Andres Wiernik 2017 Agenda: The Facts! (Epidemiology/Risk Factors) Biological Classification/Phenotypes of Breast Cancer Treatment approach Local Systemic Agenda: The Facts! (Epidemiology/Risk
More informationSentinel Lymph Node Biopsy for Breast Cancer
Sentinel Lymph Node Biopsy for Breast Cancer Registrar Tutorial Adam Cichowitz Surgical Registrar The Royal Melbourne Hospital Sentinel Lymph Node Biopsy Axillary LN status important prognostic factor
More informationAny News in EBC? Ann H. Partridge, MD, MPH Dana-Farber Cancer Institute November 11, 2016
Any News in EBC? Ann H. Partridge, MD, MPH Dana-Farber Cancer Institute November 11, 2016 Yes! Age disparities vary by tumor subtype Genomic risk prediction data in young women Adjuvant systemic therapy
More informationThe Neoadjuvant Model as a Translational Tool for Drug and Biomarker Development in Breast Cancer
The Neoadjuvant Model as a Translational Tool for Drug and Biomarker Development in Breast Cancer Laura Spring, MD Breast Medical Oncology Massachusetts General Hospital Primary Mentor: Dr. Aditya Bardia
More informationUltrasound or FNA for Predicting Node Positive in Breast Cancer
Ultrasound or FNA for Predicting Node Positive in Breast Cancer Chiun Sheng Huang, MD, PhD, MPH Professor and Chairman Department of Surgery Director of Breast Care Center National Taiwan University Hospital
More informationTriple Negative Breast Cancer: Part 2 A Medical Update
Triple Negative Breast Cancer: Part 2 A Medical Update April 29, 2015 Tiffany A. Traina, MD Breast Medicine Service Memorial Sloan Kettering Cancer Center Weill Cornell Medical College Overview What is
More informationOutcomes of patients with inflammatory breast cancer treated by breast-conserving surgery
Breast Cancer Res Treat (2016) 160:387 391 DOI 10.1007/s10549-016-4017-3 EDITORIAL Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery Monika Brzezinska 1 Linda J.
More informationESMO Breast Cancer Preceptorship Singapore November Special Issues in Treatment of Young Women with Breast Cancer
ESMO Breast Cancer Preceptorship Singapore November 2017 Special Issues in Treatment of Young Women with Breast Cancer Prudence Francis MD Peter MacCallum Cancer Centre Melbourne, Australia Conflict of
More informationLecture 5. Primary systemic therapy: clinical and biological endpoints
Lecture 5 Primary systemic therapy: clinical and biological endpoints Valentina Guarneri, M.D., Ph.D. Primary systemic therapy in breast cancer Firstly introduced d into clinical i l practice in 70s for
More informationTreatment of Early-Stage HER2+ Breast Cancer
Treatment of Early-Stage HER2+ Breast Cancer Chau T. Dang, MD Chief, MSK Westchester Medical Oncology Service Breast Medicine Service Memorial Sloan Kettering Cancer Center Disclosures I have research
More informationDR. BOMAN N. DHABHAR Consulting Oncologist Jaslok Hospital, Fortis Hospital Mulund, Wockhardt Hospital Mumbai & BND Onco Centre INDIA
Recent Advances of Docetaxel in Management of Breast Cancer DR. BOMAN N. DHABHAR Consulting Oncologist Jaslok Hospital, Fortis Hospital Mulund, Wockhardt Hospital Mumbai & BND Onco Centre INDIA 1 ADJUVANT
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, for early-stage triple-negative breast cancer, 740 742 in older early-stage breast cancer patients, 790 795 anti-her2-directed
More informationNeoadjuvantTreatment In BC When, How, Who?
NeoadjuvantTreatment In BC When, How, Who? Clifford Hudis, M.D. Chief, Breast Cancer Medicine Service, MSKCC Professor of Medicine, Weill Cornell Medical College President, ASCO 15 Potential Benefits Of
More informationCURRENT CONTROVERSIES IN BREAST CANCER SURGERY Less or more!?
CURRENT CONTROVERSIES IN BREAST CANCER SURGERY Less or more!? I have no Disclosures Wolfgang Gatzemeier Breast Unit Milan, Italy 17th ESO-ESMO- EONS Masterclass in Clinical Oncology 24-29 MARCH 2018 Optimal
More informationPoint of View on Early Triple Negative
Point of View on Early Triple Negative Valentina Rossi, MD UOSD Oncologia dei Tumori della Mammella Azienda Ospedaliera S.Camillo-Forlanini VRossi@scamilloforlanini.rm.it Outline Neoadjuvant Setting IPSY-2
More informationA Study to Evaluate the Effect of Neoadjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast
Original Research Article A Study to Evaluate the Effect of Neoadjuvant Chemotherapy on Hormonal and Her-2 Receptor Status in Carcinoma Breast E. Rajesh Goud 1, M. Muralidhar 2*, M. Srinivasulu 3 1Senior
More informationUK Interdisciplinary Breast Cancer Symposium. Should lobular phenotype be considered when deciding treatment? Michael J Kerin
UK Interdisciplinary Breast Cancer Symposium Should lobular phenotype be considered when deciding treatment? Michael J Kerin Professor of Surgery National University of Ireland, Galway and Galway University
More informationLocoregional treatment Session Oral Abstract Presentation Saulo Brito Silva
Locoregional treatment Session Oral Abstract Presentation Saulo Brito Silva Background Post-operative radiotherapy (PORT) improves disease free and overall suvivallin selected patients with breast cancer
More informationWhy Do Axillary Dissection? Nodal Treatment and Survival NSABP B04. Revisiting Axillary Dissection for SN Positive Patients
Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 10th International Congress on the Future of Breast Cancer Coronado, CA Why Do Axillary Dissection? 6 August 2011 Implications
More informationIs Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease?
Is Complete Axillary Dissection Needed Following Mastectomy and Sentinel Node Biopsy for N1 disease? Mylin A. Torres, MD Director, Glenn Family Breast Center Louis and Rand Glenn Family Chair in Breast
More informationSurgical Issues in Neoadjuvant Chemotherapy
14 th Bossche Mamma Congress Ruwenbergstraat 7 5271 AG Sint Michielsgestel June 14, 2016 Surgical Issues in Neoadjuvant Chemotherapy Tari A. King MD FACS Chief, Breast Surgery Dana Farber/Brigham and Women
More informationWhat to do after pcr in different subtypes?
What to do after pcr in different subtypes? Luca Moscetti Breast Unit Università degli Studi di Modena e Reggio Emilia Policlinico di Modena, Italy Aims of neoadjuvant therapy in breast cancer Primary
More informationIntroduction. Approximately 20% of invasive breast cancers
Introduction Approximately 2% of invasive breast cancers overexpress HER2 The current standard of care for neoadjuvant therapy is dual-targeted therapy with trastuzumab and pertuzumab plus chemotherapy
More informationTriple Negative Breast Cancer
GASCO 2016 San Antonio Breast Cancer Symposium Review Triple Negative Breast Cancer Amelia Zelnak, MD, MSc Atlanta Cancer Care Northside Hospital Cancer Institute Disclosures: consultant for Novartis,
More informationSYSTEMIC THERAPY OPTIONS FOR BREAST CANCER IN 2014
SYSTEMIC THERAPY OPTIONS FOR BREAST Oncology Day 2014 CANCER IN 2014 Dr. Katherine Enright, M.D., M.P.H., F.R.C.P.(C) Katherine.enright@Trilliumhealthpartners.ca OBJECTIVES 1. Outline an approach to the
More informationRetrospective analysis to determine the use of tissue genomic analysis to predict the risk of recurrence in early stage invasive breast cancer.
Retrospective analysis to determine the use of tissue genomic analysis to predict the risk of recurrence in early stage invasive breast cancer. Goal of the study: 1.To assess whether patients at Truman
More informationBreast Cancer: Current Approaches to Diagnosis and Treatment
Breast Cancer: Current Approaches to Diagnosis and Treatment Barbara L. Smith, MD, Ph.D. Massachusetts General Hospital Division of Surgical Oncology No Disclosures Incidence of Breast Cancer USA 2018
More informationNeo-adjuvant and adjuvant treatment for HER-2+ breast cancer
Neo-adjuvant and adjuvant treatment for HER-2+ breast cancer Angelo Di Leo «Sandro Pitigliani» Medical Oncology Unit Hospital of Prato Istituto Toscano Tumori Prato, Italy NOAH: Phase III, Open-Label Trial
More informationTriple-Negative Breast Cancer
June 2017 Triple-Negative Breast Cancer Amir Sonnenblick, MD, PhD Sharett institute of oncology Hadassah-Hebrew university medical center, Jerusalem, Israel This presentation is the intellectual property
More informationLong term survival study of de-novo metastatic breast cancers with or without primary tumor resection
Long term survival study of de-novo metastatic breast cancers with or without primary tumor resection Dr. Michael Co Division of Breast Surgery Queen Mary Hospital The University of Hong Kong Conflicts
More informationWhen is Chemotherapy indicated in Advanced Luminal Breast Cancer?
When is Chemotherapy indicated in Advanced Luminal Breast Cancer? Soo-Chin Lee Head & Senior Consultant Department of Haematology-Oncology Clinical Care National University Cancer Institute, Singapore
More informationTaking NeoadjuvantTreatment into the Clinic
Taking NeoadjuvantTreatment into the Clinic The Data and the Challenges Karen A Gelmon MD FRCPC Professor Medicine University of British Columbia Medical Oncologist BC Cancer Agency NeoadjuvantTherapy
More informationBreast Cancer Basics. Clinical Oncology for Public Health Professionals. Ben Ho Park, MD, PhD
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
More informationSurgical Advances in the Treatment of Breast Cancer. Laura Kruper, MD, MSCE Chief, Breast Surgery
Surgical Advances in the Treatment of Breast Cancer Laura Kruper, MD, MSCE Chief, Breast Surgery Nothing to disclose DISCLOSURE LESS IS MORE Radiation Lymph nodes Reconstruction Less is More! Radiation
More informationThe absolute benefit from chemotherapy for both older and younger patients appeared most significant in ER-negative populations.
Hello, my name is Diane Hecht, and I am a Clinical Pharmacy Specialist at the University of Texas MD Anderson Cancer Center. It s my pleasure to talk to you today about the role of chemotherapy in this
More informationPolicy No: dru281. Medication Policy Manual. Date of Origin: September 24, Topic: Perjeta, pertuzumab. Next Review Date: May 2015
Medication Policy Manual Topic: Perjeta, pertuzumab Committee Approval Date: May 9, 2014 Policy No: dru281 Date of Origin: September 24, 2012 Next Review Date: May 2015 Effective Date: June 1, 2014 IMPORTANT
More informationSYSTEMIC TREATMENT OF TRIPLE NEGATIVE BREAST CANCER
SYSTEMIC TREATMENT OF TRIPLE NEGATIVE BREAST CANCER Sunil Shrestha 1*, Ji Yuan Yang, Li Shuang and Deepika Dhakal Clinical School of Medicine, Yangtze University, Jingzhou, Hubei Province, PR. China Department
More informationInes Buccimazza 16 TH UP CONTROVERSIES AND PROBLEMS IN SURGERY SYMPOSIUM
BILATERAL MASTECTOMY IS NOT ROUTINELY JUSTIFIED IN PATIENTS WITH BILATERAL AXILLARY LYMPHADENOPATHY AND ONLY ONE DETECTABLE PRIMARY BREAST CANCER LESION SURGERY SYMPOSIUM Ines Buccimazza Breast Unit Department
More informationEDITORIAL. Ann Surg Oncol (2011) 18: DOI /s
Ann Surg Oncol (2011) 18:2407 2412 DOI 10.1245/s10434-011-1593-7 EDITORIAL Multidisciplinary Considerations in the Implementation of the Findings from the American College of Surgeons Oncology Group (ACOSOG)
More informationEarly and locally advanced breast cancer: diagnosis and management
Early and locally advanced breast cancer: diagnosis and management NICE guideline Draft for consultation, January 0 This guideline covers diagnosing and managing early and locally advanced breast cancer.
More informationSesiones interhospitalarias de cáncer de mama. Revisión bibliográfica 4º trimestre 2015
Sesiones interhospitalarias de cáncer de mama Revisión bibliográfica 4º trimestre 2015 Selected papers Prospective Validation of a 21-Gene Expression Assay in Breast Cancer TAILORx. NEJM 2015 OS for fulvestrant
More informationState of the Art in 2000 State of the Art today Gazing forward
2010 Buschke Lecture: The Relationship between Local Recurrence and Survival in Breast Cancer Jay R. Harris Dana-Farber Cancer Institute (DFCI) Brigham and Women s Hospital (BWH) Harvard Medical School
More informationBreast Surgery When Less is More and More is Less. E MacIntosh, MD June 6, 2015
Breast Surgery When Less is More and More is Less E MacIntosh, MD June 6, 2015 Presenter Disclosure Faculty: E. MacIntosh Relationships with commercial interests: None Mitigating Potential Bias Not applicable
More informationAdjuvant Systemic Therapy in Early Stage Breast Cancer
Adjuvant Systemic Therapy in Early Stage Breast Cancer Julie R. Gralow, M.D. Director, Breast Medical Oncology Jill Bennett Endowed Professor of Breast Cancer Professor, Global Health University of Washington
More informationResearch Article Changes in Pathological Complete Response Rates after Neoadjuvant Chemotherapy for Breast Carcinoma over Five Years
Oncology Volume 2016, Article ID 4324863, 5 pages http://dx.doi.org/10.1155/2016/4324863 Research Article Changes in Pathological Complete Response Rates after Neoadjuvant Chemotherapy for Breast Carcinoma
More informationLo Studio Geparsepto. Alessandra Fabi Oncologia Medica 1
Lo Studio Geparsepto Alessandra Fabi Oncologia Medica 1 nab-paclitaxel Versus Solvent-Based Paclitaxel in Neoadjuvant Chemotherapy for Early Breast Cancer (GeparSepto GBG 69): A Randomised, Phase III Trial
More informationClinical Practice Guidelines - Breast Disease Site
Date: (O): (R): Jan 31, 2014 Tumor Group: Breast Disease Site Group Page: 1 of 11 Issuing Authority: Dr. Jehann Siddiqui Clinical Chief, Cancer Care Program Date Signed: July 4, 2014 Adapted From: Up To
More information