SHARE and WEILL CORNELL BREAST CENTER     Metastatic breast cancer:          Update 2012           Anne Moore, MD         ...
Metastatic breast cancer• Spread of breast cancer outside of the breast  and axillary lymph nodes  – About 20-30 % of wome...
Metastatic breast cancer• Now considered “a chronic disease”• Have a strategic plan
The woman with metastatic disease• Tools:   – Surgery   – Radiation therapy   – Zometa for bone strengthening
The woman with metastatic disease• Tools:   –   Chemotherapy   –   Hormonal therapy for ER/PR positive   –   Her-2 directe...
[TITLE]
[TITLE]
Does the ER/PR/HER 2 change between  the primary cancer and the metastasis?• Estrogen receptor- 126 patients  – Was positi...
[TITLE]Luis, ASCO education session, 2012
How do we stop cancer cells from dividing?     DNA
How do we stop cancer cells from dividing?Chemotherapy directly attacks the DNA: Cells cant divide.
BUT DNA can repair itself so we need to  outsmart cell division in other ways DNA
TARGETED TREATMENT:INACTIVATE THE ESTROGEN RECEPTOR   Estrogen                              Estrogen receptor
TARGETED TREATMENT: INACTIVATE THE ESTROGEN RECEPTORTake away estrogenUse a “fake” estrogen:TamoxifenDestroy the estrogenr...
BUT the cells can bypass the estrogen receptor blockade and startto divide again so we need to outsmart estrogen dependent...
Estrogen activates the estrogen receptor and cellsproliferate through activation of the mTOR pathway
mTOR blockade blocks estrogen receptor activationBlock mTOR                     EVEROLIMUS IS AN MTOR INHIBITOR
BOLERO 2: ASCO UPDATE
RESULTS• CLINICAL BENEFIT RATE-Those women who had a complete  response, a partial response or stable disease for more tha...
Characteristics of these women with    metastatic ER+ breast cancer• Average age: 61• Disease free interval before first r...
Women receiving both pills,    Exemestane (Aromasin) and Everolimus (Afinitor)                had more side effects•   mou...
Will we use everolimus with hormone              therapy?   Pt. recurs on or after adjuvant letrozole:      Tamoxifen     ...
HER-2 POSITIVE METASTATIC BREAST CANCER
Lapatinib (Tykerb) (a pill) targets the Her2receptor              X                      X                  X
PERTUZUMAB HAS JUST BEEN APPROVED FOR HER 2 +         METASTATIC BREAST CANCER
Pertuzumab• Approved for first line metastatic breast  cancer treatment with herceptin and  docetaxel (taxotere)• Very wea...
Herceptin linked to a strong chemotherapy drug                        [TITLE]
[TITLE]
[TITLE]
[TITLE]
The Future is Promising for Metastatic Breast Cancer
Metastatic breast cancer. share seminar. june
Metastatic breast cancer. share seminar. june
Metastatic breast cancer. share seminar. june
Metastatic breast cancer. share seminar. june
Metastatic breast cancer. share seminar. june
Metastatic breast cancer. share seminar. june
Upcoming SlideShare
Loading in...5
×

Metastatic breast cancer. share seminar. june

521

Published on

Dr. Moore Presentation

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
521
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
22
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • ORR and CBR are highly significant: <0001; the final OS analysis will be conducted after 392 deaths
  • 48% had received tmx, 16% fulvestrant and 26% had one chemo regimen
  • Transcript of "Metastatic breast cancer. share seminar. june"

    1. 1. SHARE and WEILL CORNELL BREAST CENTER Metastatic breast cancer: Update 2012 Anne Moore, MD Linda Vahdat, MD Christine
    2. 2. Metastatic breast cancer• Spread of breast cancer outside of the breast and axillary lymph nodes – About 20-30 % of women treated for stage 1, 2 or 3 breast cancer will later develop metastatic cancer – Breast cancer can start as metastatic cancer
    3. 3. Metastatic breast cancer• Now considered “a chronic disease”• Have a strategic plan
    4. 4. The woman with metastatic disease• Tools: – Surgery – Radiation therapy – Zometa for bone strengthening
    5. 5. The woman with metastatic disease• Tools: – Chemotherapy – Hormonal therapy for ER/PR positive – Her-2 directed therapy for HER 2 positive – Anti-angiogenesis approach – Clinical trials • New drugs, new approaches • Vaccines• What about diet, supplements, vitamins, immune boosters?
    6. 6. [TITLE]
    7. 7. [TITLE]
    8. 8. Does the ER/PR/HER 2 change between the primary cancer and the metastasis?• Estrogen receptor- 126 patients – Was positive and now negative-14% – Was negative and now positive-8%• HER 2- 121 patients – Was positive and now negative-17% – Was negative and now positive- 0% Luis, DFCI. ASCO education session 2012
    9. 9. [TITLE]Luis, ASCO education session, 2012
    10. 10. How do we stop cancer cells from dividing? DNA
    11. 11. How do we stop cancer cells from dividing?Chemotherapy directly attacks the DNA: Cells cant divide.
    12. 12. BUT DNA can repair itself so we need to outsmart cell division in other ways DNA
    13. 13. TARGETED TREATMENT:INACTIVATE THE ESTROGEN RECEPTOR Estrogen Estrogen receptor
    14. 14. TARGETED TREATMENT: INACTIVATE THE ESTROGEN RECEPTORTake away estrogenUse a “fake” estrogen:TamoxifenDestroy the estrogenreceptor:Faslodex
    15. 15. BUT the cells can bypass the estrogen receptor blockade and startto divide again so we need to outsmart estrogen dependent celldivision in other ways
    16. 16. Estrogen activates the estrogen receptor and cellsproliferate through activation of the mTOR pathway
    17. 17. mTOR blockade blocks estrogen receptor activationBlock mTOR EVEROLIMUS IS AN MTOR INHIBITOR
    18. 18. BOLERO 2: ASCO UPDATE
    19. 19. RESULTS• CLINICAL BENEFIT RATE-Those women who had a complete response, a partial response or stable disease for more than 6 months – 26.4% for exemestane – 51.3% for exemestane and everolimus
    20. 20. Characteristics of these women with metastatic ER+ breast cancer• Average age: 61• Disease free interval before first recurrence: 5 year• All had received anastrazole or letrozole- 84% had shown a response.• 53% had received >3 treatments for metastatic disease including chemotherapy• The women were in good shape
    21. 21. Women receiving both pills, Exemestane (Aromasin) and Everolimus (Afinitor) had more side effects• mouth sores• Infections• Rash• Pneumonitis• high blood sugar
    22. 22. Will we use everolimus with hormone therapy? Pt. recurs on or after adjuvant letrozole: Tamoxifen Fulvestrant Then: ?exemestane alone or with everolimusas an alternative to chemotherapyThis trial is exciting because it opens a new pathwayfor drug development in breast cancer
    23. 23. HER-2 POSITIVE METASTATIC BREAST CANCER
    24. 24. Lapatinib (Tykerb) (a pill) targets the Her2receptor X X X
    25. 25. PERTUZUMAB HAS JUST BEEN APPROVED FOR HER 2 + METASTATIC BREAST CANCER
    26. 26. Pertuzumab• Approved for first line metastatic breast cancer treatment with herceptin and docetaxel (taxotere)• Very weak by itself but boosts herceptin effect even for women who have had herceptin already
    27. 27. Herceptin linked to a strong chemotherapy drug [TITLE]
    28. 28. [TITLE]
    29. 29. [TITLE]
    30. 30. [TITLE]
    31. 31. The Future is Promising for Metastatic Breast Cancer
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×