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Tumor Board 2014-Feb13-v7_(copy01)

200177199 202 inhibition ofgrowth tumour cell

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Unformatted text preview: yclines – Doxorubicin and epirubicin – MOA – intercalating DNA and topoisomerase II inhibition – Side effects ­ cardiomyopathy Taxanes – Docetaxel and paclitaxel – Binding of microtubules, inhibition of mitosis – Side effects – neuropathy Chemotherapy Chemotherapy Platinum – cisplatin and carboplatin – DNA damage Alkylating agent – cyclophosphamide – Attach alkyl group to DNA – DNA crosslink formation – Carcinogenic – leukemia Fluorouracil ­5FU – Thymidylate synthase inhibitor – Inhibit pyrimidine synthesis Endocrine Therapy ­ Inhibition of Estrogen­dependent Growth Tamoxifen Tamoxifen Estrogen biosynthesis Nucleus Estrogen biosynthesis Aromatase Aromatase Inhibitors Inhibitors Estrogen Estrogen Receptor Bhatnagar AS, et al. J Steroid Biochem Mol Biol. 2001;77:199-202. Inhibition of growth Tumour cell Endocrine therapy toxicities Endocrine therapy toxicities Menopausal symptoms Bone health Cardiovascular health Thromboembolic event Endometrial Cancer Targeted Biological Therapy – Targeted Biological Therapy – her2/neu Receptor Antibody Adjuvant hercetpin improves survival Small risk for cardiotoxicity Case ­ continued Case ­ continued Ms. K had adjuvant FEC chemotherapy, radiation to right breast, and 5 years of tamoxifen treatment 6 years after her initial diagnosis, she noticed increased redness and swelling in her red breast and did not respond to a short course of antibiotics She went back to see her surgeon Biopsy showed recurrent breast cancer with inflammatory features Inflammatory Breast Cancer Inflammatory Breast Cancer Neoadjuvant Therapy Neoadjuvant Therapy Is the breast lesion operable? What is neo­adjuvant therapy? – Systemic therapy – Radiation therapy – Aimed at downsizing tumor before surgery What are the Indications for Neoadjuvant Therapy? Goal Operable Inoperable Improve surgical options Deliver adequate Deliver “adjuvant” chemotherapy “adjuvant” Provide in vivo antitumour assessment Assess surrogate biologic Assess endpoints for response & survival survival Management of Locally Advanced Breast Cancer Surgical oncology Who to send for Who preoperative neo adjuvant therapy? adjuvant Medical oncology What drugs to give for What preoperative therapy? preoperative Radiation oncology Combined chemo-rads? Radiotherapy for inoperable/progressive disease despite chemo Case ­ continued Case ­ continued On clinical history, Ms. K is also complaining of back pain in the lumbar region Bone scan showed multiple metastatic bone lesions in thoracic and lumbar region Large lytic lesion in L2 and L4 on X­ray Consult Radiation oncology for palliative radiation for pain control XRT from L1­L5 Baseline Baseline New Bone Mets Case ­ continued Case ­ continued Palliative care consult for pain management Cancer Rehab Palliative systemic therapy Palliative therapy Palliative therapy Prolong life Reduce symptoms ­ QoL Disease usually not curable Multidisciplinary approach Clinical trial can be useful Metastatic Breast Cancer Is Not One Disease Two Ends of the Spectrum Rapid disease progression Extensive visceral involvement Resistance to hormonal therapy Resistance to chemotherapy Death within weeks of dx “Acute Leukemia of Breast Cancer” Long, indolent course Bone and soft tissue dz Sensitive to hormonal rx Sensitive to chemotherapy Extended survival (many yrs) “Chronic Lymphocytic Leukemia of Breast Cancer” Median survival from dx of MBC is at least 2­3 years, and probably getting longer as new treatments become available QUESTIONS? QUESTIONS?...
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