Food and Drug Administration (FDA) approved Perjeta® (pertuzumab)* in combination with Herceptin® (trastuzumab) and docetaxel chemotherapy for people with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic breast cancer.1
The combination of Perjeta, trastuzumab and docetaxel chemotherapy was the only regimen that has been shown to significantly improve the time people with previously untreated HER2-positive metastatic breast cancer lived without their disease getting worse (median progression-free survival, or PFS, 18.5 vs. 12.4 months; 6.1 months improvement) compared to trastuzumab and docetaxel chemotherapy
Pertuzumab: A novel humanized mAb for the treatment of HER2 positive breast c...Md. Mominul Islam
Pertuzumab is a novel humanized monoclonal antibody developed for the treatment of HER2 positive breast cancer. It works by selectively blocking the HER2 receptor and inhibiting the HER2-HER3 dimerization, which is the most potent dimer involved in the development of HER2 positive breast cancer. Clinical trials have shown that the combination of Pertuzumab, Trastuzumab and Docetaxel produces higher complete pathological response rates compared to Trastuzumab and Docetaxel alone in the neoadjuvant and metastatic settings. Pertuzumab is the first drug that can block the HER2-HER3 dimerization in addition to Trastuzumab and chemotherapy.
Herceptin is a monoclonal antibody approved by the FDA in 1998 to treat HER2-positive breast cancer. It binds to the HER2 receptor protein, which is overexpressed in approximately 20-30% of breast cancer tumors. This inhibits tumor cell growth and improves survival rates. Herceptin was the first targeted cancer therapy and is most effective when used in combination with chemotherapy as a first line treatment or alone for metastatic cancer. It can cause cardiac side effects but significantly improves outcomes for HER2-positive breast cancer.
1) The document discusses a symposium on trastuzumab in early breast cancer treatment.
2) Trastuzumab requires HER2 overexpression for efficacy and is associated with improved overall survival when used in the adjuvant setting for breast cancers that overexpress HER2.
3) The symposium included a question and answer session on the appropriate use and efficacy of trastuzumab in breast cancer treatment.
This document discusses the management of early HER2+ breast cancer. It defines early breast cancer and describes the HER2+ subtype, which accounts for around 25% of cases. For early HER2+ breast cancer, neoadjuvant chemotherapy plus trastuzumab improves pathological complete response rates and long-term outcomes compared to chemotherapy alone. Multiple trials demonstrate the benefit of adding pertuzumab or T-DM1 to neoadjuvant regimens. Post-neoadjuvant surgery may require close evaluation of margins due to heterogeneous response.
Report Back from ASCO 2023: What’s the Latest News in Metastatic Breast Cancer?bkling
Join Dr. Sherry Shen, breast oncologist from Memorial Sloan Kettering Cancer Center, as she breaks down the recent research from the American Society of Clinical Oncology(ASCO), 2023 Annual Meeting. She will present what all the new data means to you and answer questions that you may have.
Triple Negative Breast Cancer and Women of Color (Slide 1)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month.
Strategies for Managing Recurrent Ovarian Cancerbkling
When ovarian cancer returns, it's not uncommon to experience a range of emotions and feel overwhelmed. But it's important to remember that recurrent ovarian cancer can often be successfully treated. Dr. Shannon N. Westin, gynecologic oncologist and clinical investigator at MD Anderson Cancer Center, goes over the latest treatment options for recurrent disease.
How can immunotherapy be used to treat metastatic breast cancer? Ian Krop, MD, PhD, discusses the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 and hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
Pertuzumab: A novel humanized mAb for the treatment of HER2 positive breast c...Md. Mominul Islam
Pertuzumab is a novel humanized monoclonal antibody developed for the treatment of HER2 positive breast cancer. It works by selectively blocking the HER2 receptor and inhibiting the HER2-HER3 dimerization, which is the most potent dimer involved in the development of HER2 positive breast cancer. Clinical trials have shown that the combination of Pertuzumab, Trastuzumab and Docetaxel produces higher complete pathological response rates compared to Trastuzumab and Docetaxel alone in the neoadjuvant and metastatic settings. Pertuzumab is the first drug that can block the HER2-HER3 dimerization in addition to Trastuzumab and chemotherapy.
Herceptin is a monoclonal antibody approved by the FDA in 1998 to treat HER2-positive breast cancer. It binds to the HER2 receptor protein, which is overexpressed in approximately 20-30% of breast cancer tumors. This inhibits tumor cell growth and improves survival rates. Herceptin was the first targeted cancer therapy and is most effective when used in combination with chemotherapy as a first line treatment or alone for metastatic cancer. It can cause cardiac side effects but significantly improves outcomes for HER2-positive breast cancer.
1) The document discusses a symposium on trastuzumab in early breast cancer treatment.
2) Trastuzumab requires HER2 overexpression for efficacy and is associated with improved overall survival when used in the adjuvant setting for breast cancers that overexpress HER2.
3) The symposium included a question and answer session on the appropriate use and efficacy of trastuzumab in breast cancer treatment.
This document discusses the management of early HER2+ breast cancer. It defines early breast cancer and describes the HER2+ subtype, which accounts for around 25% of cases. For early HER2+ breast cancer, neoadjuvant chemotherapy plus trastuzumab improves pathological complete response rates and long-term outcomes compared to chemotherapy alone. Multiple trials demonstrate the benefit of adding pertuzumab or T-DM1 to neoadjuvant regimens. Post-neoadjuvant surgery may require close evaluation of margins due to heterogeneous response.
Report Back from ASCO 2023: What’s the Latest News in Metastatic Breast Cancer?bkling
Join Dr. Sherry Shen, breast oncologist from Memorial Sloan Kettering Cancer Center, as she breaks down the recent research from the American Society of Clinical Oncology(ASCO), 2023 Annual Meeting. She will present what all the new data means to you and answer questions that you may have.
Triple Negative Breast Cancer and Women of Color (Slide 1)bkling
In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month.
Strategies for Managing Recurrent Ovarian Cancerbkling
When ovarian cancer returns, it's not uncommon to experience a range of emotions and feel overwhelmed. But it's important to remember that recurrent ovarian cancer can often be successfully treated. Dr. Shannon N. Westin, gynecologic oncologist and clinical investigator at MD Anderson Cancer Center, goes over the latest treatment options for recurrent disease.
How can immunotherapy be used to treat metastatic breast cancer? Ian Krop, MD, PhD, discusses the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 and hosted by the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
This document discusses targeted therapies for breast cancer that express human epidermal growth factor receptor 2 (HER2). It describes several approved HER2-targeted agents including trastuzumab, pertuzumab, ado-trastuzumab emtansine (T-DM1), and lapatinib. It also discusses everolimus and palbociclib which target other pathways important in breast cancer. Trastuzumab was the first approved HER2-targeted monoclonal antibody and works by inhibiting HER2 signaling. Pertuzumab inhibits HER2 dimerization and is used with trastuzumab. T-DM1 delivers the chemoagent emtansine directly to HER2-positive cells. Ever
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
1. This woman presents with metastatic breast cancer to the lungs, with no prior treatment with trastuzumab.
2. Her primary breast tumor was ER+/PgR+/HER2+ and she received adjuvant letrozole but no anti-HER2 therapy.
3. Current metastases remain HER2-positive. Standard of care would be to treat with trastuzumab-based chemotherapy given her HER2-positive status and lack of prior anti-HER2 exposure.
Brentuximab vedotin is an antibody-drug conjugate used to treat Hodgkin lymphoma and systemic anaplastic large cell lymphoma. It consists of the monoclonal antibody cAC10 linked to the microtubule inhibitor MMAE. When the antibody binds to CD30 proteins on lymphoma cells, the complex is internalized and MMAE is released, disrupting the microtubule network and causing cell death. Brentuximab vedotin allows targeted delivery of the cytotoxic agent to minimize side effects compared to conventional chemotherapy. Common side effects include neuropathy, nausea, fatigue, and low blood cell counts.
Report Back from San Antonio Breast Cancer Symposium (SABCS 2022)bkling
Curious about the latest developments in Early-Stage Breast Cancer and Metastatic Breast Cancer Research? Join us as Dr. Anne Blaes, the Division Director of Hematology/Oncology/Transplantation and Professor in Hematology/Oncology at the University of Minnesota, breaks down the most recent developments released at the annual San Antonio Breast Cancer Symposium regarding early-stage and metastatic breast cancer research.
Her2Neu positive breast cancer is comprises of about 15-20% of all breast cancer. Among them quite a few number of patients present as de novo metastasis . In this presentation you ll find a guide how to manage it with relevant evidences. Presentation is meant for Oncology trainees.
Molecular BIOLOGY OF RENAL CELL CARCINOMA BY DR.PRASHANT KUMBHAJprashantkumbhaj
Renal cell carcinoma is not a single disease but has several histologic subtypes. Studies over the past two decades have identified five inherited renal cancer syndromes caused by mutations in specific genes. These include von Hippel-Lindau syndrome, hereditary papillary renal carcinoma, Birt-Hogg-Dubé syndrome, tuberous sclerosis, and mutations in tricarboxylic acid cycle enzyme genes. Identification of the mutated genes in familial forms of renal cell carcinoma has provided insights into renal carcinogenesis and helped guide clinical management.
Adjuvant Endocrine Therapy For Postmenopausal Breast CancerEmad Shash
Questions Covered in the presentation:
• Should patients receive an AI or Tamoxifen?
• Should patients receive monotherapy (AI or Tamoxifen alone) or sequential
therapy using both?
• 5 vs 10 years of therapy?
• If More than 5 years of endocrine therapy, which class to be used
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015bkling
Dr. Tiffany Traina, medical oncologist at Memorial Sloan-Kettering Cancer Center, presents the latest research on metastatic breast cancer reported at the San Antonio Breast Cancer Symposium in December 2015.
The Changing Role of PARP Inhibitors in the Treatment of Ovarian Cancerbkling
In recent years, researchers have been looking into using a class of drugs called PARP inhibitors to prevent the progression and recurrence of ovarian cancer. Dr. Kathleen Moore of Stephenson Cancer Center, Principal Investigator of the SOLO-1 trial, explains how the results of this trial may affect ovarian cancer patients and where research on ovarian cancer treatment is headed next.
This downloadable slidedeck, presented in a regional grand rounds series, focuses on increasing awareness about current and emerging treatment options for patients with newly diagnosed and recurrent ovarian cancer.
CARCINOMA OVARY- EARLY STAGE MANAGEMENTNabeel Yahiya
This document discusses staging, treatment, and survival rates for ovarian cancer. It notes that over 70% of patients present with advanced stage III or IV disease, and less than 40% of women are cured. Primary treatment consists of surgical staging and cytoreduction followed by chemotherapy. Platinum-based chemotherapy, particularly carboplatin and paclitaxel, is now the standard first-line treatment and has improved progression-free and overall survival rates compared to previous single agents or regimens. Adjuvant chemotherapy is also now recommended for early stage high risk disease to further reduce relapse rates.
Clinical trials are testing new HER2-targeted therapies for metastatic HER2-positive breast cancer. Some highlights of ongoing trials include a trial of Trastuzumab Deruxtecan for patients resistant to T-DM1, a trial adding hormonal therapy Fulvestrant to Neratinib, and a trial combining immunotherapy with chemotherapy and Trastuzumab. Participating in clinical trials helps advance treatment options and many trials provide access to promising new agents. Talking to your oncologist can help identify potential trials and determine if participation may be an option.
From Alzahra Oncology Center in Dubai, in the heart of Middle East lead by Dr Sadir Alrawi AMERICAN boarded, minimal invasive surgery, with Dr Thamir Alkasab, Khaled Koutech and Dr Ziad Aluobiadi
This document summarizes hormonal treatment for breast cancer, including the history and mechanisms of various endocrine therapies. It discusses the timeline of developments in hormonal therapies from the late 19th century to present, covering areas like surgical oophorectomy, tamoxifen, aromatase inhibitors, and more. Key findings and mechanisms of different therapies like tamoxifen, aromatase inhibitors, and fulvestrant are summarized. The optimal use and duration of adjuvant tamoxifen therapy is discussed based on various clinical trials. The relationship between tamoxifen benefit and estrogen/progesterone receptor status is also covered.
Apalutamide is a drug developed to treat non-metastatic castration-resistant prostate cancer. It works as a competitive antagonist of the androgen receptor by binding to it more efficiently than other drugs and preventing the receptor's nuclear localization. Clinical trials found apalutamide to be well tolerated and resulted in significant reductions in PSA levels in patients, demonstrating its robust anti-tumor activity for this cancer type.
This document discusses a clinical trial evaluating the combination of ribociclib and endocrine therapy for pre/perimenopausal women with HR+, HER2- advanced breast cancer. The trial aimed to assess whether ribociclib plus an aromatase inhibitor and goserelin improved progression-free survival compared to placebo plus the same endocrine therapies. Key findings were that the combination led to a statistically significant improvement in progression-free survival. Overall survival data were also collected as a secondary outcome.
The document discusses classification and treatment of triple negative breast cancer (TNBC). It begins with an overview of TNBC classification including molecular subtypes. It then describes the clinical characteristics and prognosis of TNBC compared to other breast cancer types. Treatment options discussed include chemotherapy with taxanes and platinum agents shown to be effective. Other potential targeted therapies mentioned include PARP inhibitors, EGFR inhibitors, angiogenesis inhibitors, and tyrosine kinase inhibitors.
What are the latest treatment advances for HER2-positive metastatic breast cancer? Eric Winer, MD, director of the Breast Cancer Program in the Susan F. Smith Center for Women's Cancers, discusses some of the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
Pertuzumab for HER2 Positive Metastatic Breast CancerRod Bugawan
Pertuzumab is a targeted therapy for HER2-positive metastatic breast cancer. The CLEOPATRA trial found that first-line treatment with pertuzumab, trastuzumab, and docetaxel prolonged progression-free survival by 6.1 months compared to placebo, trastuzumab, and docetaxel. Subgroup analyses from CLEOPATRA found that pertuzumab provided clinical benefit in older (≥65 years) and younger (<65 years) patients, with a manageable safety profile in both age groups.
This document discusses the past, present, and future of neoadjuvant treatment in breast cancer. It describes how neoadjuvant therapy was initially used for inoperable breast cancer but is now commonly used for operable breast cancer to increase the rate of breast conservation. Recent trials show that adding targeted therapies like trastuzumab to chemotherapy regimens for HER2-positive breast cancer significantly improves pathological complete response rates compared to chemotherapy alone. Ongoing research is exploring the use of newer targeted agents and combinations in the neoadjuvant setting to further improve outcomes.
This document discusses targeted therapies for breast cancer that express human epidermal growth factor receptor 2 (HER2). It describes several approved HER2-targeted agents including trastuzumab, pertuzumab, ado-trastuzumab emtansine (T-DM1), and lapatinib. It also discusses everolimus and palbociclib which target other pathways important in breast cancer. Trastuzumab was the first approved HER2-targeted monoclonal antibody and works by inhibiting HER2 signaling. Pertuzumab inhibits HER2 dimerization and is used with trastuzumab. T-DM1 delivers the chemoagent emtansine directly to HER2-positive cells. Ever
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
1. This woman presents with metastatic breast cancer to the lungs, with no prior treatment with trastuzumab.
2. Her primary breast tumor was ER+/PgR+/HER2+ and she received adjuvant letrozole but no anti-HER2 therapy.
3. Current metastases remain HER2-positive. Standard of care would be to treat with trastuzumab-based chemotherapy given her HER2-positive status and lack of prior anti-HER2 exposure.
Brentuximab vedotin is an antibody-drug conjugate used to treat Hodgkin lymphoma and systemic anaplastic large cell lymphoma. It consists of the monoclonal antibody cAC10 linked to the microtubule inhibitor MMAE. When the antibody binds to CD30 proteins on lymphoma cells, the complex is internalized and MMAE is released, disrupting the microtubule network and causing cell death. Brentuximab vedotin allows targeted delivery of the cytotoxic agent to minimize side effects compared to conventional chemotherapy. Common side effects include neuropathy, nausea, fatigue, and low blood cell counts.
Report Back from San Antonio Breast Cancer Symposium (SABCS 2022)bkling
Curious about the latest developments in Early-Stage Breast Cancer and Metastatic Breast Cancer Research? Join us as Dr. Anne Blaes, the Division Director of Hematology/Oncology/Transplantation and Professor in Hematology/Oncology at the University of Minnesota, breaks down the most recent developments released at the annual San Antonio Breast Cancer Symposium regarding early-stage and metastatic breast cancer research.
Her2Neu positive breast cancer is comprises of about 15-20% of all breast cancer. Among them quite a few number of patients present as de novo metastasis . In this presentation you ll find a guide how to manage it with relevant evidences. Presentation is meant for Oncology trainees.
Molecular BIOLOGY OF RENAL CELL CARCINOMA BY DR.PRASHANT KUMBHAJprashantkumbhaj
Renal cell carcinoma is not a single disease but has several histologic subtypes. Studies over the past two decades have identified five inherited renal cancer syndromes caused by mutations in specific genes. These include von Hippel-Lindau syndrome, hereditary papillary renal carcinoma, Birt-Hogg-Dubé syndrome, tuberous sclerosis, and mutations in tricarboxylic acid cycle enzyme genes. Identification of the mutated genes in familial forms of renal cell carcinoma has provided insights into renal carcinogenesis and helped guide clinical management.
Adjuvant Endocrine Therapy For Postmenopausal Breast CancerEmad Shash
Questions Covered in the presentation:
• Should patients receive an AI or Tamoxifen?
• Should patients receive monotherapy (AI or Tamoxifen alone) or sequential
therapy using both?
• 5 vs 10 years of therapy?
• If More than 5 years of endocrine therapy, which class to be used
SHARE Webinar: Latest Research on Metastatic Breast Cancer from SABCS 2015bkling
Dr. Tiffany Traina, medical oncologist at Memorial Sloan-Kettering Cancer Center, presents the latest research on metastatic breast cancer reported at the San Antonio Breast Cancer Symposium in December 2015.
The Changing Role of PARP Inhibitors in the Treatment of Ovarian Cancerbkling
In recent years, researchers have been looking into using a class of drugs called PARP inhibitors to prevent the progression and recurrence of ovarian cancer. Dr. Kathleen Moore of Stephenson Cancer Center, Principal Investigator of the SOLO-1 trial, explains how the results of this trial may affect ovarian cancer patients and where research on ovarian cancer treatment is headed next.
This downloadable slidedeck, presented in a regional grand rounds series, focuses on increasing awareness about current and emerging treatment options for patients with newly diagnosed and recurrent ovarian cancer.
CARCINOMA OVARY- EARLY STAGE MANAGEMENTNabeel Yahiya
This document discusses staging, treatment, and survival rates for ovarian cancer. It notes that over 70% of patients present with advanced stage III or IV disease, and less than 40% of women are cured. Primary treatment consists of surgical staging and cytoreduction followed by chemotherapy. Platinum-based chemotherapy, particularly carboplatin and paclitaxel, is now the standard first-line treatment and has improved progression-free and overall survival rates compared to previous single agents or regimens. Adjuvant chemotherapy is also now recommended for early stage high risk disease to further reduce relapse rates.
Clinical trials are testing new HER2-targeted therapies for metastatic HER2-positive breast cancer. Some highlights of ongoing trials include a trial of Trastuzumab Deruxtecan for patients resistant to T-DM1, a trial adding hormonal therapy Fulvestrant to Neratinib, and a trial combining immunotherapy with chemotherapy and Trastuzumab. Participating in clinical trials helps advance treatment options and many trials provide access to promising new agents. Talking to your oncologist can help identify potential trials and determine if participation may be an option.
From Alzahra Oncology Center in Dubai, in the heart of Middle East lead by Dr Sadir Alrawi AMERICAN boarded, minimal invasive surgery, with Dr Thamir Alkasab, Khaled Koutech and Dr Ziad Aluobiadi
This document summarizes hormonal treatment for breast cancer, including the history and mechanisms of various endocrine therapies. It discusses the timeline of developments in hormonal therapies from the late 19th century to present, covering areas like surgical oophorectomy, tamoxifen, aromatase inhibitors, and more. Key findings and mechanisms of different therapies like tamoxifen, aromatase inhibitors, and fulvestrant are summarized. The optimal use and duration of adjuvant tamoxifen therapy is discussed based on various clinical trials. The relationship between tamoxifen benefit and estrogen/progesterone receptor status is also covered.
Apalutamide is a drug developed to treat non-metastatic castration-resistant prostate cancer. It works as a competitive antagonist of the androgen receptor by binding to it more efficiently than other drugs and preventing the receptor's nuclear localization. Clinical trials found apalutamide to be well tolerated and resulted in significant reductions in PSA levels in patients, demonstrating its robust anti-tumor activity for this cancer type.
This document discusses a clinical trial evaluating the combination of ribociclib and endocrine therapy for pre/perimenopausal women with HR+, HER2- advanced breast cancer. The trial aimed to assess whether ribociclib plus an aromatase inhibitor and goserelin improved progression-free survival compared to placebo plus the same endocrine therapies. Key findings were that the combination led to a statistically significant improvement in progression-free survival. Overall survival data were also collected as a secondary outcome.
The document discusses classification and treatment of triple negative breast cancer (TNBC). It begins with an overview of TNBC classification including molecular subtypes. It then describes the clinical characteristics and prognosis of TNBC compared to other breast cancer types. Treatment options discussed include chemotherapy with taxanes and platinum agents shown to be effective. Other potential targeted therapies mentioned include PARP inhibitors, EGFR inhibitors, angiogenesis inhibitors, and tyrosine kinase inhibitors.
What are the latest treatment advances for HER2-positive metastatic breast cancer? Eric Winer, MD, director of the Breast Cancer Program in the Susan F. Smith Center for Women's Cancers, discusses some of the latest research and treatment options.
This presentation was originally given as part of the 2015 Metastatic Breast Cancer Forum, held on October 17 at Dana-Farber Cancer Institute in Boston, Mass.
For more information, visit www.susanfsmith.org
Pertuzumab for HER2 Positive Metastatic Breast CancerRod Bugawan
Pertuzumab is a targeted therapy for HER2-positive metastatic breast cancer. The CLEOPATRA trial found that first-line treatment with pertuzumab, trastuzumab, and docetaxel prolonged progression-free survival by 6.1 months compared to placebo, trastuzumab, and docetaxel. Subgroup analyses from CLEOPATRA found that pertuzumab provided clinical benefit in older (≥65 years) and younger (<65 years) patients, with a manageable safety profile in both age groups.
This document discusses the past, present, and future of neoadjuvant treatment in breast cancer. It describes how neoadjuvant therapy was initially used for inoperable breast cancer but is now commonly used for operable breast cancer to increase the rate of breast conservation. Recent trials show that adding targeted therapies like trastuzumab to chemotherapy regimens for HER2-positive breast cancer significantly improves pathological complete response rates compared to chemotherapy alone. Ongoing research is exploring the use of newer targeted agents and combinations in the neoadjuvant setting to further improve outcomes.
1) Reassessment of hormone receptor and HER2 status when breast cancer metastasizes can provide important information to guide treatment, as discordance rates between primary and metastatic tumors have been found to be as high as 30-50% for hormone receptors and 10-15% for HER2 in some studies.
2) Early administration of anti-HER2 targeted therapy for HER2-positive breast cancer is important, as several studies have shown improved outcomes when trastuzumab is started concurrently or shortly after diagnosis of metastatic disease rather than at later stages.
3) Continuing HER2-targeted therapy beyond progression on initial regimens provides clinical benefit, as evidenced by trials showing improved outcomes with extended trast
postmastectomy radiotherapy after neo adjuvant chemotherapy in breast cancerBharti Devnani
This document summarizes a journal club discussion on postmastectomy radiation therapy (PMRT) in the context of neoadjuvant chemotherapy (NACT). It discusses evidence from retrospective studies that PMRT improves outcomes for patients with stage III disease, residual nodal disease after NACT, or other high-risk features. While PMRT may not benefit all node-negative patients, its role in specific subgroups like triple-negative or young patients requires further study. Ongoing trials aim to clarify the benefits of PMRT for patients with a complete pathological response or early-stage disease after NACT. Prospective data are still needed regarding personalized treatment decisions incorporating both clinical and pathological risk factors.
Kimberly L. Blackwell, MD, discusses breast cancer in this CME activity titled "Raising the Bar in HER2-Positive Breast Cancer: Improving Patient Outcomes in the Neoadjuvant Setting". For the full presentation, downloadable practice aids, transcript, complete CME information, and to apply for credit please visit us at http://bit.ly/2e2aj2P. CME credit will be available until July 26, 2017.
This document discusses locally advanced breast cancer and summarizes key points about its presentation, diagnosis, and treatment approaches. Approximately 20-25% of breast cancer patients present with locally advanced disease, including inflammatory breast cancer which represents 1-3% of cases. Long-term survival of around 50% is possible with a multimodality treatment approach. Neoadjuvant chemotherapy is effective for locally advanced, inoperable breast cancer and can improve surgical options. Anthracycline-based regimens like FEC and AC are common choices. The addition of taxanes may increase response rates. Neoadjuvant trastuzumab combined with chemotherapy significantly improves outcomes for HER2-positive locally advanced breast cancer.
Pathological assesment of carcinoma breast after neoadjuvant chenotherapy.imrana tanvir
This document discusses neoadjuvant therapy (NAT), which involves giving patients systemic agents before surgical removal of breast tumors. NAT was initially used for locally advanced tumors but is now being used for earlier-stage cancers. Studies have shown NAT and adjuvant therapy provide identical loco-regional control and metastasis-free survival. Advantages of NAT include increased eligibility for breast conservation and allowing assessment of treatment efficacy and tumor response. The document then describes a study of 40 breast cancer patients who received NAT, where pathological assessment after surgery found varying levels of tumor reduction according to the Miller-Payne classification system. Accurate pathological classification and reporting of residual disease after NAT is important for evaluating new treatments and clinical trials.
This document describes a multidisciplinary cancer management course on locally advanced primary breast cancer held in Cairo, Egypt from April 5-6, 2007. It covers the natural history and clinical presentation of locally advanced breast cancer, the diagnostic workup, TNM staging system, treatment options including chemotherapy, radiation and surgery, and survival outcomes based on different treatment approaches. The goal of systemic therapies for breast cancer is to attain cure, prevent recurrence, and eradicate micrometastases.
The document summarizes several international guidelines for treating breast cancer, including the St. Gallen, ASCO, NCCN, and AGO guidelines. The St. Gallen guidelines classify risk based on endocrine responsiveness. The NCCN guidelines recommend aromatase inhibitors for 5 years or switching from tamoxifen to an AI after 2-3 years. The ASCO guidelines also recommend aromatase inhibitors for 5 years or switching from tamoxifen to an AI after 2-5 years for no more than 5 years total on the AI.
The breast is composed of lobes, lobules, and ducts. It receives its blood supply from the internal and external mammary arteries. Lymph drainage is primarily to the axillary lymph nodes.
Breast anatomy and development can vary between individuals. Common benign breast conditions include fibroadenomas, cysts, and fibrocystic changes.
Breast cancer originates in the breast ducts or lobules. HER2-positive breast cancer is a type where cancer cells overexpress the HER2 receptor, causing rapid growth. Physical signs may include a painless breast mass, nipple retraction, and enlarged lymph nodes.
The document discusses breast anatomy, benign breast diseases, and risk factors for breast cancer. Some key points:
- Breast tissue is composed of lobules that drain into ducts leading to the nipple. Lymphatic drainage is primarily to axillary lymph nodes.
- The most common benign breast condition is fibrocystic changes, which causes breast tenderness and nodularity.
- Studies have found that women with benign breast disease involving atypical hyperplasia have a 2-5x increased risk of developing breast cancer later in life compared to women without these histologic findings. Early detection of breast abnormalities can improve breast cancer prognosis.
Breast cancer is the most important medical challenge that we are facing in present time. I want to focus on the breast cancer after taking about normal anatomy and development of the breast. I will concern about: 1. what is the breast cancer! 2. Clinical features 3. How to detect 4. Management and prognosis.
I want to work and keep researching on Breast cancer to find the remedy to save lives.
breast is the mammary gland with lobes and ductules with lactiferous ducts.
it extends from 2nd intercostal to 6 intercostal ribs and lies over pectoralis major muscle
This document provides an overview of breast carcinoma, including its anatomy, etiology, epidemiology, clinical presentation, classification, staging, diagnosis, and management. Some key points include:
- Breast carcinoma is the most common cancer in women worldwide and a leading cause of cancer death. Risk factors include genetics, hormones, lifestyle.
- The breast is composed of lobules that drain into ducts and is supported by ligaments. Lymph nodes in the axilla are the primary drainage site.
- Clinical presentation varies from asymptomatic to palpable lumps, skin changes, nipple abnormalities. Mammography and biopsy are used for diagnosis.
- Treatment involves surgery (mastectomy or lumpectomy), radiation,
This PPT was designed as a "Seminar Presentation" for Department of Surgery, SGRD Medical College.
It list complete guide as to how to proceed when encountered with a case of lump breast/carcinoma breast
This document provides information about breast cancer, including:
1) It defines breast cancer as a malignant tumor that starts in breast cells and can spread to other parts of the body.
2) Known risk factors include family history, age, and certain genetic mutations, though most women who get breast cancer have no known risk factors.
3) There are two main types of breast cancer - non-cancerous tumors and cancerous tumors that can metastasize to other organs. Prognosis depends on factors like cancer type and stage.
This document provides information about benign breast disease and anatomy. It discusses the normal breast anatomy including lobes, lobules, ducts, ligaments, blood and lymph supply. It then covers benign breast conditions such as cysts, fibroadenomas, mastitis and fibrocystic changes. Gynecomastia and various types of nipple discharge are also mentioned. The document provides a brief overview of malignant breast diseases.
Describe the normal anatomy of the breast in female ?
Describe the breast cancer and its different type ,stages and grading ?
List the tumor marker of breast cancer ?
Clinical significance of progesterone and estrogen in breast cancer ?
How the breast cancer spread in different sites ?
Define the paraneoplastic syndrome ?
This document provides an overview of breast anatomy, risk factors for breast cancer, and common presentations of breast cancer. It describes the structure and vasculature of the breast in detail. The most important risk factors are increasing age, family history and genetic mutations. Most women present with a hard, painless lump in the breast, though some lumps can cause discomfort. Thorough examination of any breast lump is important for early diagnosis.
The document provides details on the anatomy of the female breast:
- The breast is made up of 15-20 lobules of glandular tissue embedded in fat, separated by fibrous septa and ligaments. Each lobule drains into lactiferous ducts that empty into the nipple.
- The blood supply comes from branches of the axillary, internal thoracic, and intercostal arteries. Lymphatic drainage is primarily to the axillary nodes but also to internal mammary nodes.
- During pregnancy and lactation, the breast enlarges as alveoli develop from the ducts to produce milk. After weaning or menopause, the secretory tissue undergoes involution.
Cancer is the abnormal, uncontrollable replication of cells which can lead to tumor formation. Breast cancer forms in the breast tissues and spreads mainly through the lymphatic system to the lymph nodes under the arm, around the collarbone, and inside the chest near the breastbone. Diagnostic tests for breast cancer include breast exams, mammograms, breast ultrasounds, breast MRIs, and biopsies. If breast cancer is detected, stages are determined based on tumor size and spread to lymph nodes and distant organs to help guide treatment planning.
The document provides information on the anatomy and physiology of the breast and axilla. It discusses the location, structures, size, shape, appearance and development of the breast. It also covers the blood supply, lymph system and lymph nodes of the axilla. The document outlines aspects of health history to inquire about including the reason for seeking care, personal and family medical history, and current health. It describes examining the breasts and axillae by inspecting and palpating them.
This document provides an overview of breast carcinoma, including its development, anatomy, risk factors, subtypes, and diagnosis. It begins with the development of the breast from fetal stages through adulthood. It describes the anatomy of the breast including blood supply, lymphatic drainage, and subareolar plexus. Risk factors associated with breast carcinoma include age, family history, personal history, reproductive history, and lifestyle factors. The document discusses the molecular subtypes of breast cancer and genes associated with inherited forms. It provides details on non-invasive and invasive breast carcinomas and concludes with an overview of the clinical examination and workup for diagnosing breast cancer.
This document provides an overview of breast cancer including its:
1) Anatomy, signs and symptoms, types, stages, and grades.
2) Causes such as genetic and hormonal factors.
3) Methods of diagnosis including physical exam, mammography, and biopsy.
4) Treatment options including surgery, chemotherapy, radiation, hormone therapy and targeted therapy.
1. The document provides an overview of the gross anatomy of the uterus, including its parts, position, relations, blood supply, and supports.
2. The uterus has a pear-shaped body and a narrow lower cervix. It is situated in the pelvis between the urinary bladder and rectum. The body provides an environment for fetal development and the cervix connects to the vagina.
3. Key structures include the uterine cavity containing the developing embryo, as well as ligaments like the broad and round ligaments that support the uterus in its normal anteverted, anteflexed position.
USMLE ENDOCRINE 04 Mammary glands breast ANATOMY MEDICAL .pdfAHMED ASHOUR
Surgery plays a crucial role in the management of various breast conditions, including both benign and malignant disorders. Understanding the surgical options for breast conditions is essential for breast surgeons, oncologists, and other healthcare professionals involved in breast care.
The choice of surgery depends on the specific diagnosis, patient preferences, and the overall treatment plan.
Surgical interventions aim to address the underlying condition, restore aesthetics when relevant, and contribute to the overall well-being of individuals with breast-related health concerns.
Thyroid Cancer & Differential Diagnosis of Lumps in Neck for Medical Students...meducationdotnet
Performing an ultrasound guided fine needle aspiration (FNA) is crucial for distinguishing between benign and malignant thyroid masses. The results are usually expressed using the THY cytology grading system, which ranges from non-diagnostic (THY1) to diagnostic of malignancy (THY5). Additional useful investigations include thyroid function tests to rule out hyper or hypothyroid conditions, as any mass with euthyroid biochemistry should be suspected as cancer. Together, FNA cytology and thyroid function tests help establish the diagnosis prior to further management.
The document provides information about breast cancer including:
1. Breast cancer is the most common cancer and second leading cause of cancer death for women in the USA.
2. Survival rates for breast cancer have been increasing due to factors like adjuvant chemotherapy and hormone therapy as well as screening.
3. Risk factors for breast cancer include age, family history, genetic factors, lifestyle factors like alcohol consumption and obesity.
Gazyva is a medicine that works with the body’s own immune system to attack blood cells called B-cells that have a certain marker on their surface (CD20). B-cells are the cause of common blood cancers.1,2
Gazyva is FDA-approved for the treatment of people with previously untreated chronic lymphocytic leukemia (CLL) in combination with chlorambucil chemotherapy.3
Phase III clinical data showed that Gazyva plus chlorambucil chemotherapy helped people with CLL live longer without the disease worsening than chlorambucil chemotherapy alone.3
Noise in the background - you are not concentrating on the sounds at all and nothing is registering with you. Ignoring would be another way to describe this type of listening. There is nothing wrong with passive listening if it's truly not important, but passive listening - which we might more aptly call Not Listening - is obviously daft and can be downright dangerous if the communications are important.
The time has come for HR (Human Resources) departments to call it a day. HR departments often portray themselves as a valued business partner for management and staff alike. However, how can anyone take a department seriously that refers to people as ‘resources’? Nothing matters more to companies than the people who work there. Companies are nothing without the right people! And I am sure that not one, single individual wants to be referred to as a ‘human resource’.So, the first point I want to make is that the name is wrong: very wrong. It signals to everyone that this department manages ‘human resources’ in a top-down fashion, i.e. managing humans in a similar way to other resources such as finance, property or machines. If departments can’t see that this is sending out the wrong messages, then they don’t deserve to be there anyway.
The document discusses the nature and characteristics of services. It notes that services are intangible, inseparable, variable, and perishable. It also discusses the distinctive characteristics of services like intangibility where services cannot be seen before purchase. It discusses how marketers can address these characteristics through strategies like standardizing service delivery to reduce variability. The document also discusses marketing strategies for services, noting people, physical evidence, and process must be considered in addition to the traditional 4Ps. It emphasizes the importance of internal marketing to train employees.
PowerPoint provides numerous features that offers flexibility and the ability to create a professional presentation. One of the features provides the ability to create a presentation that includes music which plays throughout the entire presentation or sound effects for particular slides. In addition to the ability to add sound files, the presentation can be designed to run, like a movie, on its own. PowerPoint allows the user to record the slide show with narration and a laser pointer. You may customize slide shows to show the slides in different order than originally design and to have slides appear multiple times
pricing involves the customer demand schedule, the cost function, and competitors’ prices. The question is how should a company integrate cost-, demand-, and competition-based pricing considerations? In setting a price the firm, for example Kodak, will have to consider the following cost-, demand-, and competition-based pricing decisions:
An internship is a method of on-the-job training for white-collar and professional careers. Internships for professional careers are similar to apprenticeships for trade and vocational jobs. Although interns are typically college or university students, they can also be high school students or post-graduate adults. On occasion, they are middle school or even elementary students. In some countries, internships for school children are called work experience. Internships may be paid or unpaid, and are usually understood to be temporary positions.
Winning isn't everything--but wanting to win is. Winning is a state of mind that embraces everything you do. Winning isn't everything, but the will to win is everything. “A winner is someone who recognizes his God-given talents, works his tail off to develop them into skills, and uses these skills to accomplish his goals. Winning is not everything, but the effort to win is. Winning isn't everything, it's the only thing
We will look at the laws of motivation. One could argue that they are principles rather than laws, but I prefer to use the word ‘laws’ because it implies that if you break them, you will receive a penalty.
I love the art of selling. LOVE IT. When I first entered the field of sales, the one thing I quickly grew to appreciate was the fact that anything I did to increase my ability in selling also increased my ability in life. Sales skills are life skills
A sales person is a tool to get your offering out to prospects and/or customers. It’s true we can control the offering and we can shape the message presented. But it’s the Sales person’s style, presentation and skills that will determine how the customer or prospect will feel about usIT’S NOT WHAT YOU SAY IT IS. IT’S HOW THEY SAY IT
A group of chronic CNS disorders characterized by recurrent seizures.
Seizures are sudden, transitory, and uncontrolled episodes of brain dysfunction resulting from abnormal discharge of neuronal cells with associated motor, sensory or behavioral changes.
Diabetes Mellitus Is Due To A Disorder Of Carbohydrate, protein And Lipid Metabolism As A Result Of An Absolute Or Deficiency In Metabolically Active Insulin.
Mental Disorders makeup 5 of the 10 leading causes of disability world wide – Anxiety being one of the major shareholders
Likely increase approximately 50% by 2020
Most of the conditions respond well to treatment –right approach is vital.More than 90% of the patients turn up in General practitioners’ clinic initially.Socio-economic situation / social taboos resulting in avoidance to seek medical advice.Recent Earthquake disaster in Japan is likely to increase the number by thousands
An ulcer is a sore in the lining of the stomach or duodenum (the first part of the small intestine). People of any age can acquire an ulcer. Women are affected just as often as men.
Companies that have prospered over long periods of time through multiple product life cycles and several generations of leadership. six years of intensive, qualitative research on what makes winning companies exceptional and different including their practices and habits.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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3. PERJETA® is a first-line treatment for HER2positive metastatic breast cancer.
• PERJETA is an FDA-approved
treatment for HER2-positive
metastatic breast cancer. It is
a targeted therapy used as
part of a first-line HER2positive metastatic breast
cancer treatment plan, in
combination with Herceptin
(trastuzumab) and docetaxel
(chemotherapy).
5. PERJETA is referred to as a HER2
dimerization inhibitor (HDI).
• Learn more about HDIs.
6. HER family receptors are activated by ligand-induced
dimerization, or receptor pairing.3 Dimerization is a critical
step in HER family-mediated signaling, and HER receptors
are able to homodimerize or heterodimerize with
7.
8. What is HER2-positive breast cancer?
All cells have HER2 receptors, including healthy cells and cancer cells. In
HER2-positive breast cancer, tumor cells have more HER2 receptors than
normal. Too much HER2 makes these cancer cells grow and divide too
rapidly.
NONCANCEROUS CELL
9. What is HER2-positive breast cancer?
All cells have HER2 receptors, including healthy cells and cancer cells. In HER2-positive breast
cancer, tumor cells have more HER2 receptors than normal. Too much HER2 makes these
cancer cells grow and divide too rapidly.
HER2-POSITIVE CANCER CELL
Cancer treatments called HER2-targeted therapies have been
developed to target the HER2 receptor.
PERJETA is one of those HER2-targeted therapies.
10. PERJETA is a targeted therapy for treating HER2-positive metastatic breast cancer.
PERJETA was designed to search
for and attack cancer cells with
too much HER2
HER2 tells cancer cells to grow by
sending signals
HER2 works by sending signals
that tell cells to grow and divide
One way that HER2 can send
signals is by pairing with other
HER receptors. This process is
called dimerization
11. PERJETA is a targeted therapy for treating HER2-positive metastatic breast cancer.
PERJETA works with Herceptin to target
HER2
PERJETA and Herceptin both target HER2
but work in different ways
PERJETA is thought to block one method
of signaling so that certain receptors are
unable to pair (dimerization) with HER2
Together, PERJETA and Herceptin are
thought to create a stronger blockade
against HER2 signals, helping to slow
down cancer cell growth
HER2 signaling could inhibit the growth of tumors.
12.
13. PERJETA is proven to help control cancer growth
Adding PERJETA to Herceptin and docetaxel (chemotherapy) increased the time people
lived without their cancer growing or spreading by an average of 50%, compared with
people who took Herceptin and docetaxel (chemotherapy) alone
14. ERJETA helped people live longer
On average, people who were given PERJETA, Herceptin, and docetaxel
(chemotherapy) lived significantly longer than people given only Herceptin and
docetaxel (chemotherapy)
PERJETA is proven to shrink tumors
80% of people taking the PERJETA combination had their tumors shrink, compared to
69% of people taking Herceptin and docetaxel (chemotherapy) alonePeople who had
their tumors shrink maintained this response, on average, for 62% longer on the
PERJETA combination compared with people taking only Herceptin and docetaxel
(chemotherapy) (20.2 months vs 12.5 months)
PERJETA is taken together with Herceptin, another HER2 therapy
PERJETA is a targeted therapy used as part of a first-line HER2-positive metastatic
breast cancer treatment plan. This treatment plan includes Herceptin and docetaxel, a
type of chemotherapy. PERJETA and Herceptin both target HER2 but are believed to
work in complementary ways. The combination may increase death of cancer cells.
16. I. Introduction/General Information
A. Embryologically: belong to integument
B. Functionally: part of reproductive
system
1. Respond to sexual stimulation
2. Feed babies
17. Breast, continued …
C. Modified apocrine sweat glands
- apex of cell becomes part of secretion
and breaks off
D. Present in males and females
18. II. Anatomy
A. Position and Attachment
1. Lateral aspect of pectoral region
2.
3.
4.
5.
Located between ribs 3 and 6/7
Extend form sternum to axilla
Surrounded by superficial fascia
Rest on deep fascia
20. Position & attachment, continued ….
6. Fixed to skin & underlying
fascia by fibrous C.T. bands
a. Cooper’s (Suspensory)
Ligaments
b. Ligaments may retract when
breast tumors are present
22. Position & attachment, continued …
6. Left breast is usually slightly larger
7. Base is circular, either flattened or
concave
8. Separated from pectoralis major
muscle by fascia, retromammary
space
24. Anatomy, continued …
B. Structure
1. Outer surface convex, skin covered
2. Nipple:
a. At fourth intercostal space
b. Small conical/cylindrical
prominence below center
26. Structure, continued …
c. Surrounded by areola: pigmented
ring of skin
d. Thin skinned region lacking hair,
sweat glands
e. Contains areolar glands
27. Structure, continued …
3. Areola: contains dark pigment that
intensifies with pregnancy
a. Circular and radial smooth muscle fibers
b. Cause nipple erection
29. Structure, continued …
4. Each breast consists of ~ 20 lobes
of secretory tissue
a. Each lobe has one lactiferous duct
b. Lobes (and ducts) arranged radially
c. Embedded in connective tissue &
adipose of superficial fascia
d. Lobes composed of lobules
e. Lobules comprise alveoli
31. Structure, continued …
5. Excretory (lactiferous) ducts
converge toward areola
a. Form ampullae (collection sites of
lactiferous sinuses)
b. Ducts become contracted at base of
nipple
33. Structure, continued …
6. Secretory epithelium
a. Changes with hormonal signals
b. Onset of menstruation
c. Pregnancy (glands begin to enlarge at 2nd month)
d. After birth, 1st secretion is colostrom (contain
antibodies)
34. Structure, continued …
7. “Tail of Spence” = axillary tail
a. prolongation of upper, outer
quadrant in axillary direction
b. Passes under axillary fascia
c. May be mistaken for axillary lymph
nodes
36. Structure, continued …
8. Fatty Tissue: surrounds surface, fills
spaces between lobes
a. Determines form & size of breast
b. No fatty deposit under nipple &
areola
38. Structure, continued …
C. Vessels & nerves
1. Arteries: derived from thoracic
branches of three pairs of arteries
a. Axillary arteries
1) continuous with subclavian a.
2) gives rise to external mammary
( = lateral thoracic) artery
39. Vessels & Nerves, continued …
b. Internal mammary (thoracic) arteries
1) first descending branch of
subclavian artery
2) supply intercostal spaces & breast
3) used for coronary bypass surgery
c. Intercostal arteries:
1) numerous branches from internal
& external mammary arteries
2) supply intercostal spaces & breast
40. Arterial Supply to the Breast
Subclavian a.
Axillary a.
External
mammary
(thoracic) a.
Internal
mammary
(thoracic) a.
41. Vessels & Nerves, continued …
2. Veins:
a. form a ring around the base of the
venosus”)
nipple (“circulus
b. Large veins pass from circulus venosus to circumference of
mammary gland, then to
c. External mammary v to axillary v
or
d. Internal mammary v to subclavian v
43. Breast Anatomy, con’t…
3. Innervation: derived from:
a. anterior & lateral cutaneous
nerves of thorax
b. spinal segments T3 – T6
44. Structure, continued …
4. Lymphatics: clinically significant!
a. Glandular lymphatics drain into anterior axillary (pectoral)
nodes
central axillary nodes apical nodes
deep cervical nodes
subclavicular (subclavian) nodes
b. Medial quadrants drain into parasternal nodes
45. Lymph Nodes of the Breast
Subclavian
nodes
Axillary
nodes
Lateral
pectoral
nodes
Parasternal
nodes
46. Lymphatics, continued …
c. Superficial regions of skin, areola, nipples:
-form large channels & drain into pectoral nodes
d. NOTE: axillary nodes also drain lymph from arm
48. Routes of Metastasis
• From medial lymphatics to parasternal nodes
– Then to mediastinal nodes
• Across the sternum in lymphatics to
opposite side via cross-mammary pathways
– Then to contralateral breast
• From subdiaphragmatic lymphatics to nodes in
abdomen
– Then to liver, ovaries, peritoneum
49. Major Routes of Metastasis
Channels to Contralateral Breast
Axillary Lymph Channels
Subdiaphragmatic Lymph Channels
50. Structure, continued …
D. Anomalies
1. Inverted nipple: congenital or due
to cancer
2. Ectopic nipple:
a. “polythelia” or “hyperthelia”
b. additional nipples along milk line
3. Amastia
4. Micromastia
51. Anomalies, continued …
5. Macromastia
6. Gynecomastia
a. breast development of male in areolar region
b. noted in males who smoke marijuana at
puberty
52. III. Diseases of the Breast
A. Most are readily detectable
B. Etiology unknown, influencing factors
1. Sex
2. Heredity
53. Diseases of the breast, continued …
3. Endocrine influence
a. Menstruation – tenderness from fluid engorgement
b. Post-menopause
1) decrease of fibro-cystic disease
2) increase in cancer
c. Pregnancy
54. Diseases of the Breast, continued …
C. General symptoms & signs
1. Nipple discharge
a. always significant if not pregnant.
b. May be due to benign pituitary tumor.
2. Local pain, tenderness
3. Duration of lesion
4. Size, rate of growth
55. Symptoms & Signs, continued …
5. Retraction sign: “dimpling” involving
skin, nipple or areola
6. Mobility of mass
a. Benign = movable
1) not attached
2) not invasive
b. Malignant = attached
1)May grow into bone
56. Symptoms & Signs, continued …
7. Consistency of mass
a. Cysts = fluctuant; compressible
b. Fibroadenoma = rubbery
c. Carcinoma = firm, hard (like gravel)
8. Axillary area lymph node enlargement
57. D. Benign breast conditions
1. Infection = usually during or after
lactation
a. Recurrent, subareolar abscess
b. TB of the breast
2. Trauma = contusion
3. Hypertrophy = seen in either sex at adolescence
a. Gynecomastia = in males
58. Hypertrophy, continued …
b.
Other causes
1) testicular or pituitary tumor
2) cirrhosis
3) hypogonadism = not enough testosterone
4) estrogen administration for prostate cancer
60. Breast cancer originates in breast
tissue and arises from the ductal
tissue of the breast and, less
commonly, the lobulartissue. There
are several forms of breast cancer
based, in part, on cellular and
genetic characteristics,
62. HER2-Positive
Overabundance of the HER2 protein
classifies the breast cancer as HER2positive and causes breast cancer
cells to multiply, spread more rapidly,
and survive longer than other
breast cancers
64. Hormone Receptor-Positive
Breast cancer cells that express
hormone receptors for estrogen
(ER) and/or progesterone (PR)
are dependent on the signaling
of those receptors
72. Mammography
• Use a low-dose x-ray system to examine
breasts
• Digital mammography replaces x-ray
film by solid-state detectors that
convert x-rays into electrical signals.
These signals are used to produce images
that can be displayed on a computer
screen (similar to digital cameras)
• Mammography can show changes in the
breast up to two years before a
physician can feel them
72
73. Computer-Aided Diagnosis
• Mammography allows for efficient
diagnosis of breast cancers at an
earlier stage
• Radiologists misdiagnose 10-30%
of the malignant cases
• Of the cases sent for surgical
biopsy, only 10-20% are
actually malignant
CAD systems
can assist
radiologists to
Reduce these
problems
National Cancer Institute
73
74. What Mammograms Show
Two of the most important mammographic
indicators of breat cancers
– Masses
– Microcalcifications: Tiny flecks of calcium – like
grains of salt – in the soft tissue of the breast
that can sometimes indicate an early cancer.
74
75. Detection of Malignant Masses
Malignant masses have a more spiculated
appearance
benign
malignant
75
76. Mammogram – Difficult Case
• Heterogeneously dense breast
• Cancer can be difficult to
detect with this type of
breast tissue
• The fibroglandular tissue
(white areas) may hide the
tumor
• The breasts of younger
women contain more glands
and ligaments resulting in
dense breast tissue
76
77. Mammogram – Easier Case
• With age, breast tissue
becomes fattier and has
fewer glands
• Cancer is relatively easy
to detect in this type of
breast tissue
77
78. Different Views
Side-to-Side
MRI - Cancer can have a unique
appearance – many small irregular
white areas that turned out to be
cancer (used for diagnosis)
Top-to-Bottom
78
81. Tumors and Cysts, con’t…
b. Breast Cyst
1. Benign
2. May be aspirated
if large
82. Benign conditions, continued …
c. Fibrocystic breast
changes
1) 20%+ of remenopausal
women
2) discomfort, cysts
3) treatment rarely
required
4) More likely to not
detect a developing
cancer
83. Tumors & cysts, continued ….
d. Intraductal papilloma
- may produce “chocolate”
or
bloody
discharge from nipple
e. Lipoma: common
- fatty tumors
84. Carcinoma of the breast
1.
Most common malignant tumor among
women
2. 1/8 of women will develop breast cancer
a. 1/6 in Orange County
b. 1/5 in San Francisco
3. Generally no discomfort
86. Carcinoma of breast, continued …
4.
Physical signs:
a.
b.
c.
d.
e.
Slowly growing, painless mass
May demonstrate retracted nipple
May be bleeding from nipple
May be distorted areola, or breast contour
Skin dimpling in more advanced stages with
retraction of Cooper’s ligaments
87. Physical signs, continued …
f. Attachment of mass
g. Edema of skin
1)with “orange skin” appearance (peau d’orange)
2) due to blocked lymphatics
h. Enlarged axillary or deep cervical lymph nodes
88. Breast Cancer, con’t…
5. Common sites for metastasis
a. Lungs & pleura
b. Skeleton system (skull, vertebral column,
pelvis)
c. Liver
6. Atypical carcinomas
a. Inflammatory carcinoma (hormonal,
chemotherapy)
b. Paget’s disease of the breast
pagget's
disease
89. Scalar Field
• A scalar field is a n-dimensional space
with a scalar value attached to each
point in the space (e.g., a gray-scale
image)
89
90. Scalar Field and Gradient
• A scalar field is a n-dimensional space
with a scalar value attached to each
point in the space (e.g., a gray-scale
image)
• The derivative of a scalar field results
in a vector field called the gradient
– i.e., the gradient is a vector field
• which points in the direction of the greatest
rate of increase of the scalar field, and
• whose magnitude is the greatest rate of change
90
Black representing
Higher values
91. Gradient
The derivative of a scalar field
results in a vector field called
the gradient
– i.e., the gradient is a vector
field
• which points in the direction of
the greatest rate of increase
of the scalar field, and
• whose magnitude is the
greatest rate of change
91
Black representing
Higher values
92. Cartesian Gradient
g (P )
For an image function
I(P) where P is a pixel,
the Cartesian gradient
at P is:
I ( P)
92
I ( P)
y
I ( P)
x
tan
Magnitude:
Orientation:
arctan
P
x
I ( P)
y
g ( P)
( P)
(P)
I ( P)
y
I ( P)
x
m( P)
I ( P)
x
2
I ( P)
y
2
I ( P)
y
I ( P)
x
93. Radial Gradient
• The radial gradient
vector has the same
magnitude as the
Cartesian gradient
vector, but
• the orientation is given
as:
r ( P)
93
( P)
( P)
Radial gradient
r(P)
g (P )
(P)
P
(P)
94. Feature: Spiculation
[Huo et al.]
• Extract the mass using a
region-growing technique
• The maximum gradient and
its angle relative to the
radial direction are
computed
• Calculate the full-width at
half-maximum (FWHM)
from the cumulative
gradient orientation
histogram
94
95. Feature: Spiculation [Chan et al.]
• Determine the outline of
the segmented mass
• Obtain the rubber-bandstraightening-transformed
image
– The spicules become
approximately aligned in a
similar direction
• The rectangular region can
then be subjected to
texture analysis
95
96. Breast Calcifications
• Calcifications show up as
white spots on a mammogram
• Round well-defined, larger
calcifications (left column)
are more likely benign
• Tight cluster of tiny,
irregularly shaped
calcifications (right column)
may indicate cancer
96
97. Calcification Features
• The morphology of individual
calcification, e.g., shape, area,
and brightness
• The heterogeneity of
individual features
characterized by the mean,
the standard deviation, and
the maximum value for each
feature.
• Cluster features such as total
area, compactness
97
98. Database Approach to
Computer-Aided Diagnosis
Content-based image retrieval techniques can provide radiologists
“visual aids” to increase confidence in their diagnosis
• The database consists of a large
number of images with verified
pathology results
• Diagnosis is done by submitting
the suspected mass region as a
query to retrieve similar cases
from the database
98
99. A Mammography CAD System
[Giger et al.]
Probability of
malignancy
Similar images of
known diagnosis
Indicates the unknown
lesion relative to all
lesions in the database
99
100.
101. DESCRIPTION
PERJETA® (Pertuzumab)is a recombinant humanized monoclonal
antibody that targets the extracellular dimerization domain
(Subdomain II) of the human epidermal growth factor receptor 2
protein (HER2). Pertuzumab is produced by recombinant DNA
technology in a mammalian cell (Chinese Hamster Ovary) culture
containing the antibiotic, gentamicin. Gentamicin is not detectable
in the final product. Pertuzumab has an approximate molecular
weight of 148 kDa.
PERJETA is a sterile, clear to slightly opalescent, colorless to pale
brown liquid for intravenous infusion. Each single use vial contains
420 mg of pertuzumab at a concentration of 30 mg/mL in 20 mM
L-histidine acetate (pH 6.0), 120 mM sucrose and 0.02%
polysorbate 20.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
103. PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
104. Pharmacokinetics
PERJETA® Pertuzumab demonstrated linear
pharmacokinetics at a dose range of 2 – 25
mg/kg. Based on a population PK analysis that
included 481 patients, the median clearance
(CL) of pertuzumab was 0.24 L/day and the
median half-life was 18 days. With an initial
dose of 840 mg followed by a maintenance
dose of 420 mg every three weeks thereafter,
the steady-state concentration of pertuzumab
was reached after the first maintenance dose.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
105. INDICATIONS AND USAGE
1.1 Metastatic Breast Cancer (MBC)
PERJETA is indicated for use in
combination with trastuzumab and
docetaxel for the treatment of patients
with HER2-positive metastatic breast
cancer who have not received prior antiHER2 therapy or chemotherapy for
metastatic disease.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
106. INDICATIONS AND USAGE
1.2 Neoadjuvant Treatment of Breast Cancer
PERJETA is indicated for use in combination with
trastuzumab and docetaxel for the neoadjuvant treatment
of patients with HER2-positive, locally advanced,
inflammatory, or early stage breast cancer (either greater
than 2 cm in diameter or node positive) as part of a
complete treatment regimen for early breast cancer. This
indication is based on demonstration of an improvement
in pathological complete response rate. No data are
available demonstrating improvement in event-free
survival or overall surviva
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
107. DOSAGE AND ADMINISTRATION
The initial dose of PERJETA is 840 mg administered as a
60-minute intravenous infusion, followed every 3
weeks by a dose of 420 mg administered as an
intravenous infusion over 30 to 60 minutes.
When administered with PERJETA, the recommended
initial dose of trastuzumab is 8 mg/kg administered as a
90-minute intravenous infusion, followed every 3
weeks by a dose of 6 mg/kg administered as an
intravenous infusion over 30 to 90 minutes.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
108. DOSAGE AND ADMINISTRATION
Metastatic Breast Cancer (MBC)
When administered with PERJETA, the
recommended initial dose of docetaxel is 75
mg/m2 administered as an intravenous infusion.
The dose may be escalated to 100 mg/m2
administered every 3 weeks if the initial dose is
well tolerated.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
109. DOSAGE AND ADMINISTRATION
Neoadjuvant Treatment of Breast Cancer
PERJETA should be administered every 3 weeks for 3 to 6 cycles as part of one of the
following treatment regimens for early breast cancer [see Clinical Studies (14.2)]:
Four preoperative cycles of PERJETA in combination with trastuzumab and docetaxel
followed by 3 postoperative cycles of fluorouracil, epirubicin, and cyclophosphamide (FEC) as
given in Study 2
Three preoperative cycles of FEC alone followed by 3 preoperative cycles of PERJETA in
combination with docetaxel and trastuzumab as given in Study 3
preoperative cycles of PERJETA in combination with docetaxel, carboplatin, and
Six
trastuzumab (TCH) (escalation of docetaxel above 75 mg/m2 is not recommended) as given
in Study 3
Following surgery, patients should continue to receive trastuzumab to complete 1 year of
treatment. There is insufficient evidence to recommend continued use of PERJETA for greater
than 6 cycles for early breast cancer. There is insufficient evidence to recommend
concomitant administration of an anthracycline with PERJETA, and there are no safety data
to support sequential use of doxorubicin with PERJETA.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
110. DOSAGE AND ADMINISTRATION
Dose Modification
For delayed or missed doses, if the time between two sequential
infusions is less than 6 weeks, the 420 mg dose of PERJETA should be
administered. Do not wait until the next planned dose. If the time
between two sequential infusions is 6 weeks or more, the initial dose of
840 mg PERJETA should be re-administered as a 60-minute intravenous
infusion followed every 3 weeks thereafter by a dose of 420 mg
administered as an intravenous infusion over 30 to 60 minutes.
PERJETA should be discontinued if trastuzumab treatment is
discontinued.
Dose reductions are not recommended for PERJETA.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
111. Preparation for Administration
Administer as an intravenous infusion only. Do not administer as an
intravenous push or bolus. Do not mix PERJETA with other drugs.
Preparation
Prepare the solution for infusion, using aseptic technique, as follows:
1. Parenteral drug products should be inspected visually for particulates and
discoloration prior to administration.
2. Withdraw the appropriate volume of PERJETA solution from the vial(s).
3. Dilute into a 250 mL 0.9% sodium chloride PVC or non-PVC polyolefin
infusion bag.
4. Mix diluted solution by gentle inversion. Do not shake.
5. Administer immediately once prepared.
6. If the diluted infusion solution is not used immediately, it can be stored at
2oC to 8oC for up to 24 hours.
7. Dilute with 0.9% Sodium Chloride injection only. Do not use dextrose (5%)
solution.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
112. DOSAGE FORMS AND STRENGTHS
PERJETA (pertuzumab) 420 mg/14 mL
(30 mg/mL) in a single-use vial
CONTRAINDICATIONS
PERJETA is contraindicated in patients with known
hypersensitivity to pertuzumab or to any of its
excipients.
PERJETA® is a first-line treatment for HER2-positive metastatic breast cancer.
113. HER2 Testing
Detection of HER2 protein overexpression is necessary for selection of patients
appropriate for PERJETA therapy because these are the only patients studied
and for whom benefit has been shown [see Indications and Usage (1) and
Clinical Studies (14)]. Patients with breast cancer were required to have
evidence of HER2 overexpression defined as 3+ IHC or FISH amplification ratio
2.0 in the clinical studies. Only limited data were available for patients,whose
breast cancer was positive by FISH, but did not demonstrate protein
overexpression by IHC.
114. HER2 Testing
Assessment of HER2 status should be performed by laboratories using FDAapproved tests with demonstrated proficiency in the specific technology being
utilized. Improper assay performance, including use of sub-optimally fixed tissue,
failure to utilize specified reagents, deviation from specific assay instructions, and
failure to include appropriate controls for assay validation, can lead to unreliable
results.
115. ADVERSE REACTIONS
Metastatic Breast Cancer
1. The most common adverse reactions (> 30%) with PERJETA in
combination with trastuzumab and docetaxel were diarrhea, alopecia,
neutropenia, nausea, fatigue, rash, and peripheral neuropathy.
Neoadjuvant Treatment of Breast Cancer
1. The most common adverse reactions (> 30%) with PERJETA in
combination with trastuzumab and docetaxel were alopecia, diarrhea,
nausea, and neutropenia.
2. The most common adverse reactions (>30%) with PERJETA in
combination with trastuzumab and docetaxel when given for 3 cycles
following 3 cycles of FEC were fatigue, alopecia, diarrhea, nausea,
vomiting, and neutropenia.
3. The most common adverse reactions (>30%) with PERJETA in
combination with docetaxel, carboplatin, and trastuzumab (TCH) were
fatigue, alopecia, diarrhea, nausea, vomiting, neutropenia,
thrombocytopenia, and anemia.