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Breast Cancer in the Developing World: Meeting the Unforeseen Challenge to Women, Health, Equity Towards an Inclusive Clinical Trials Research Agenda. Julie R. Gralow, M.D. Professor and Director, Breast Medical Oncology University of Washington School of Medicine
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Breast Cancer in the Developing World: Meeting the Unforeseen Challenge to Women, Health, Equity
Towards an Inclusive Clinical Trials Research Agenda
Julie R. Gralow, M.D.
Professor and Director, Breast Medical Oncology
University of Washington School of Medicine
Fred Hutchinson Cancer Research Center
Seattle Cancer Care Alliance
Luminal Subtype A
Luminal Subtype B
Sorlie et al, Proc NatlAcadSci 100:8418, 2003
Patient DifferencesPharmacogenomics: Inherited Differences in Enzymes that Metabolize Cancer Drugs Can Lead to Differences in Efficacy and Toxicity
We inherit different forms of the enzyme that metabolizes
% of US Caucasian population
What are the genetics in the rest of the world?
Tamoxifen is an inactive drug – it needs to be converted to its active forms
Plasma endoxifen levels
Jin Y et al, J Natl Cancer Inst 2005
Treatment project goal:
To define effective, practical therapies that can be delivered safely
20 Year Follow-up of a Milan Study
If chemotherapy is given, it should be given at the full dose as proven to work in clinical trials
<65% of dose
65-84% of dose
85% of dose
Probability of Overall Survival
Years after Mastectomy
Bonadonna G et al, N Engl J Med 332,1995
Ukraine Preoperative Chemotherapy Clinical Trial: Designed in Partnership
Biopsy for diagnosis of invasive breast cancer (+ tissue bank)
Evaluation of local/regional and possible metastatic disease
ADRIAMYCIN 60 mg/m2 + CYTOXAN 600 mg/m2
Intravenously every 3 weeks x 4 doses
(Trial supplied chemotherapy only, no supplies or supportive care drugs)
Mastectomy or lumpectomy with lymph node dissection
Not specified per study: Could include further chemotherapy, hormone therapy, or radiation