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Breast Cancer Adjuvant therapy Update

Presentation to The Annual Current Therapy Seminar, Portsmouth, OH Li-Fen Lien Chang, MD PhD Radiation Oncology Department SOMC Cancer Center 10/23/2009. Breast Cancer Adjuvant therapy Update. Paradigm Shift: RT Less is more?.

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Breast Cancer Adjuvant therapy Update

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  1. Presentation to The Annual Current Therapy Seminar, Portsmouth, OH Li-Fen Lien Chang, MD PhD Radiation Oncology Department SOMC Cancer Center 10/23/2009 Breast Cancer Adjuvant therapyUpdate

  2. Paradigm Shift: RT Less is more? • The importance of radiation therapy for breast cancer is well established (multiple phase III randomized trials and Level1 evidence) • Without local regional control of cancer, one can not achieve a cure. • As the systemic therapy become more effective, the local regional control become even more important.

  3. Accelerated Partial Breast Irradiation (APBI) Then Whole Breast Irradiation after lumpectomy: standard of care for early stage breast cancer patient. It take 6 ½ weeks daily EBRT. Now APBI (Accelerated Partial Breast Irradiation); 5 years of follow up data indicates same effectiveness and less side effect, less time consuming ( 5 days BID fractionation). Patient selection is the key

  4. Who is a candidate for APBI? Invasive Ductal Carcinoma <3cm Negative lymph nodes Clear margin The skin -balloon surface distance >7mm >45 yo

  5. MammoSite: Breast Brachytherapy

  6. Tissue Conformance CT Image of MammoSite Skin Spacing Balloon Diameter & Symmetry 3-Dimensional rendering of applicator surface

  7. Contura MLB (Multilumen Balloon) applicator Contura is the newest generation of brachytherapy applicators which enable the radiation dose to target more of the breast tissue that is a concern while minimizing the radiation dose to healthy tissue. Suction ports allows removal of air or seroma.

  8. SOMC Cancer Center HDR treatment suit

  9. Hormonal Therapy: for ER+, PR+ Then: Tamoxifen for 5 years Evista achieve the same effectiveness Now: Postmenopausal women Aromatase inhibitor (AI) is better then Tamoxifen Premenopausal women Tamoxifen

  10. Who needs chemotherapy? Then >1cm, positive lymph nodes, <50yo, high tumor grade, high DNA S phase, Now Oncotype DX: a 21-gene expression profile Recurrent Score: Low risk, Intermediate risk or high risk group MammaPrint: a 70-gene expression profile

  11. Oncotype DX Recurrent Score

  12. Targeted Therapy: effective and low toxicity Then: no known specific target Now: HER2/neu+: Trastuzumab (Herceptin), Lapatinib (Tykerb) VGEF: Bevacezumab (Avastin) HER1:Gefitinib (Irressa)

  13. Triple Negative Breast Cancer: ER/PR/Her2- under the age of 40, Black or Hispanic more aggressive Higher five years recurrence Higher mortality rate Basoloid cell BRCA1/2 mutation PARP (poly (ADP-ribose) polymerase) inhibitor increase the chemotherapy effectiveness

  14. Tailored therapy: Whole breast radiation APBI (Accelerated Partial Breast Irradiation) Oncotype Dx Recurrent Score  who to give chemotherapy ER/PR+ Postmanopausal women AIs (Aromatase Inhibitors) are better then Tamoxifen HER2/Neu+ woman  Herceptin Triple negative (ER/PR/HER2-) Breast cancer PARP inhibitors improve out come Paradigm Shift for Breast Cancer Adjuvant Therapy

  15. Miami beach photo by Li-Fen

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