Top Banner
Advanced Breast Lesion Treatment Didier BOURGEOIS, MD Surgery Team of Henri Hartmann Breast InsAtute Neuilly-Sur-Seine - FRANCE
26

D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

Jan 20, 2017

Download

Health & Medicine

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

AdvancedBreastLesionTreatment

DidierBOURGEOIS,MDSurgeryTeamofHenriHartmannBreastInsAtute

Neuilly-Sur-Seine-FRANCE

Page 2: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

DefiniAonl  StadeIIIUICC

l  StadeIIIAl  T0,1,2N2M0l  T3N1,2M0

l  StadeIIIBouT4N0,1,2M0l  StadeIIIC

l  TxN3M0

l  InflammatorydeseaseT4dwometastasis

Page 3: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

IntroducAonl  5%metastaAc

l  20–30%chanceofdevelopingmetastasis

l  MedianSurvival:30–36month

l  5-yearSurvival:5–10%

Page 4: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

Incidencel  Geographicvariability

l  RareinNorthAmerica&inEurope

l  Buthighprevalenceinunderdevelopedcountry

Page 5: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

Incidence&Clinicalappearancel  Inwelldevelopedcountry:oldwomancancer

l  InUnderdevelopedcountry:youngwomancancer

l  Wideheterogeneityl  Tumoralphenotypel  MetastasisevoluAvity

l  Notthesametreatment

l  NotthesamepronosAc

Page 6: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

PronosAcFactors1l  PaAent-relatedFactors

l  Agel  Comorbidity

l  Cancer-relatedFactorsl  TumoralPhenotypel  FreeIntervalwometastasisl  Metastasissite:Bones/Visceral/Skin/Nodesl  NumberofmetastaAcsitel  NumberoflinesofChemotherapy

Page 7: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

PronosAcFactors2l  Tumoral-relatedFactors

l  HormonalReceptorsl  OverexpressionHER2

Page 8: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

PredictorsofResponsel  HormonalReceptors

l  OverexpressionHER2

l  ModificaAonsofthesefactorsduringtreatmentl  Biopsy+++helptoadjusttreatment

Page 9: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

RaAonalityl  LocaltreatmentwithsurgeryandradiotherapyisnoteffecAve

l  Generaltreatmentwithchemotherapyorhormonotherapy

l  TobringthepaAenttothesurgery

Page 10: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

Whatkindofgeneraltreatment?l  Foragoodlocalresponse,itdependsofthetumoralphenotype

l  Hormonalreceptorsl  HER2overexpressedl  MitosisindexwithKI67

l  IldependsoftheageofthepaAent,menopausalstatusandherwellness

Page 11: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

LocalyAdvancedCancerofoldwomanl  OncogeriatricconsultaAon

l  DiscussionwithfamilyandpaAent

l  ChemotherapyiftriplenegaAv

l  HormonaltreatmentwithfirstorsecondgeneraAonofinhibitorofaromatasel  Anastrozole,letrozole,exemestanel  Tamoxifenel  Fulvestrant

Page 12: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

FailureofHormonotherapyl  Everolimus(Afinitor®)withexemestane

Page 13: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

ChemotherapyopAonl  Rapidlyprogressivedesease

l  Lowprobabilityofresponseofhormonotherapy

l  Youngwoman

Page 14: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

ChemotherapyopAonl  Docetaxel+Capecitabine

l  Taxane+Gemcitabine

l  5-FU+Navelbine(Fun)

l  HER2+Tumors:CT+trastuzumabl  Taxanel  Capecitabinel  Vinorelbine

Page 15: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

ChemotherapyopAon(Failure)l  CT+Bevacizumab(AvasAn®)

Page 16: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

LocalyAdvancedCancerofyoungWomanl  Chemotherapy

l  WithTaxansandcyclophosphamideTACl  Withtranstuzumab

l  80%ofgoodandverygoodrespons

l  Surgicaltreatmentacceptedwithmastectomy

Page 17: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

LocalyAdvancedCancerofyoungWomanl  Recurrenceofcancer:2ndlineofchemotherapy

l  Dependsondelayofrecurrencel  >/<2years

l  Maintenancetreatmentwithbevacizumab(opAonnal)

l  DuraAonoftreatment?l  DeseaseevoluAonl  Maximalaccumulateddosel  CumulaAvtoxicityl  PaAentchoice

Page 18: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp

HAKSexperience-Cambodia

Page 19: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 20: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 21: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 22: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 23: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 24: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 25: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp
Page 26: D bourgeois localy advanced breast cancer treatment jfim hanoi 2015 comp