Metastatic breast cancer one size does not fit all
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Metastatic Breast Cancer: One Size Does Not Fit All. Clifford Hudis, M.D. Chief, Breast Cancer Medicine Service MSKCC. Breast cancer is predictable but not absolutely. Invasive Ductal Carcinoma. Message Pathways Inside Cancer Cells.

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Metastatic breast cancer one size does not fit all

Metastatic Breast Cancer: One Size Does Not Fit All

Clifford Hudis, M.D.Chief, Breast Cancer Medicine Service

MSKCC






Er negative
ER Negative and HER2


HER2 Positive and HER2





Apoptosis genes (n=641) patient.

Cytoskeleton genes (n=641)


Five Kinds Of Breast Cancer? patient.

HER-2+/ER-

Luminal B

Luminal A

Basal-like

Normal

Sorlie T et al, PNAS 2001


Challenges

Molecular profiles are: patient.

Variable by population studied

Poorly adapted for clinical use

Biology as yet not well characterized

Relationship to conventional chemotherapy response not well characterized

Ability to correctly identify molecular targets not yet proven

Challenges


Unsupervised Cluster Analysis of 99 primary breast carcinomas from MSKCC tumor bank


IHC for differentially expressed genes in ER(-) Class A carcinomas from MSKCC tumor bank

Class A

Class A

Class B

Class B

ALCAM

p<0.0001

ALCAM

p=0.023

A

B

SPDEF

SPDEF

p<0.0001

p<0.0001

A

B

AR

p<0.0001

AR

p=0.04

A

B


Real world now

Your doctor makes an educated guess about the pace of the disease and treats accordingly.

You and your doctor regularly assess the benefits of specific treatments and adjust accordingly

Real World - Now


Real world future

Your doctor tests your cancer AND your normal cells. disease and treats accordingly.

You and your doctor rationally select therapy predicted to control or cure the disease.

Real World - Future


Breast Cancer Medicine Service, MSKCC: 2005 disease and treats accordingly.


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