Tumor Board 2014-Feb13-v7_(copy01)

Significantcomorbidities patientpreference

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Unformatted text preview: Brachioplexopathy Cardiac Morbidity Second Malignancy Impact on Reconstruction (contracture, complication rates) Adjuvant Systemic Treatment Adjuvant Systemic Treatment Given in addition to the primary treatment – eg. after breast cancer surgery To eliminate micrometastasis To improve Disease Free Survival (DFS) and Overall survival (OS ) Clinically assess the risk of disease recurrence based on tumor biology Risk Assessment Risk Assessment Cancer pathological features – TNM, grade of tumor, lymphvascular invasion – ER/PR/Her2 – Molecular subtype / gene signatures Patient health status – Healthy vs. Significant co­morbidities Patient preference Clinical tools ­ Adjuvant online! www.adjuvantonline.com www.adjuvantonline.com Breast Cancer Molecular Classification Classification ER(­) ER(+) Solie et al. PNAS 2001; 98:10869­10874 Molecular Typing and Survival Molecular Typing and Survival Luminal A Normal breast­like Luminal B+C Basal type Her­2 Overall Survival (mon.) Relapse free Survival (mon.) Solie et al. PNAS 2001; 98:10869­10874 Adjuvant Systemic Treatment Adjuvant Systemic T Chemotherapy – Anthracyclines – Taxanes Endocrine therapy – SERM – eg. tamoxifen – Aromatase Inhibitors Targeted biological therapy – Anti­her2/neu antibody – eg. trastuzumab EBCTCG overview – tamoxifen vs. not EBCTCG overview – tamoxifen vs. not ERpoor Recurrence <50y NO chemo ER­positive Recurrence NO chemo chemo chemo 50­69 ECTCG overview, Lancet Vol 365, May 14, 2005, p1687­1717 ECTCG overview, Lancet Vol 365, May 14, 2005, p1687­1717 Chemotherapy Chemotherapy Anthrac...
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