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FRANCESCO BOCCARDO

FRANCESCO BOCCARDO. INIBITORI DELL’AROMATASI. (back from San Antonio). Professore Ordinario di Oncologia Medica, Università di Genova. Direttore Oncologia Medica B IST .Genova. Presidente Nazionale Associazione Italiana Oncologia Medica. Decision Points. Tamoxifen. Aromatase inhibitor.

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FRANCESCO BOCCARDO

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  1. FRANCESCO BOCCARDO INIBITORI DELL’AROMATASI (back from San Antonio) Professore Ordinario di Oncologia Medica, Università di Genova Direttore Oncologia Medica BIST .Genova Presidente Nazionale Associazione Italiana Oncologia Medica

  2. Decision Points Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years 1 ? ? 4 3 ? 2 3 ? ? ? 4

  3. Decision Points:after 2-3 yrs of Tam IES ABCSG8/ARNO95 ITA ? 1 Tamoxifen ? Aromatase inhibitor 5 years total 10 years total > 10 years

  4. The Lancet 9561:533-5, 2007

  5. The Lancet 9561:533-5, 2007

  6. The Lancet 9561:533-5, 2007

  7. AIOG Metanalysis

  8. ……….back from San Antonio 2008: take home #1 “There is a clear benefit (including a S benefit) in switching women already on treatment with Tam to an AI (anastrozole,exemestane) unless AI therapy is contraindicated”

  9. Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years Decision Points: Initial choice ? ? ATAC BIG 1-98 monotherapy TEAM 2.75 yr 2 ? ? ?

  10. ATAC:100 mos median follow-up , Lancet Oncology 2007

  11. AIOG Metanalysis

  12. : TEAM trial

  13. ……….back from San Antonio 2008: take home #2 Which drug or which patients?”

  14. Predicting the benefit and the risks. Tamoxifen vs Ais: Tumor Profile ERPgR HER2 Recurrence Score Cyclin E uPA/uPAI-1 Bcl-2 ER-beta Patient Profile Osteoporosis Hypercholesterolemia CV risk factors Endometrial pathologies DVT & TE risk factors SSRI use CYP 19 Genotype CYP2D6 Genotype

  15. TRANSACT

  16. ABCSG 8

  17. ……….back from San Antonio 2008: take home #3 Starting with an Ai is a reasonable choice especially in certain patient subsets (i.e. PgRneg,HER2 pos,HRScore Node neg,poor metabolizers of CYP2D6….!):however: 1) no major survival advantge yet 2) No over rate in selecting patients

  18. Decision Points:sequencing Tamoxifen Aromatase inhibitor 5 years total 10 years total > 10 years 1 ? ? 4 3 ABCSG8 TEAM 5-yr: n.a. yet ? 2 3 BIG-1-98 ? ? ? 4

  19. 1849+1865-792= 2922

  20. Actually received treatment

  21. Actually received treatment

  22. Sequencing versus LTZ

  23. Take home #3

  24. DOUBLE TRIAL Switch point Examestane(3 years) LTZ/ANA (2 years) Randomize Primarysurgery LTZ/ANA(2 years) LTZ/ANA(3 years) Switching period Sequencing period

  25. ……….back from S. Antonio 2008: Take home #4 “sequencing TAM with an Ai is better than TAM alone,but it does not offer major advantages vs Ai alone; switching from an Ai to TAM is possible if required… “

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