Metastatic Breast Cancer

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Treatment of Metastatic Breast Cancer

• Dr.Mohammad Dorchin
• Clinical Oncologist
• Dezfol University of Medical Sciences

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Introduction

• Metastatic breast cancer is an important problem
  in women throughout the world.
• It is the leading cause of cancer death of women
  aged lt 50 years.

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• Therefore, a big number of researches, studies
  and clinical trials about this disease and the
  best management of it.

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Systemic Treatment Approach for Metastatic
Breast Cancer
Metastatic Breast Cancer

• Limited metastases (bone soft tissue)
• Positive hormone receptors
• Hormone responsive
• Disease-free interval ?2 years

• Extensive disease or visceral crisis
• Negative hormone receptors
• No response to hormones

Hormonal Therapy
Chemotherapy
Response
No response
Progression of disease
No progression
If disease progresses, second-line hormonal
therapy
Second-line chemotherapy
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Hormone positive post-menopausal Metastatic
Breast Cancer
Antiestrogen or Nonsteroidal Aromatase Inhibitor
(AI)
First line
Nonsteroidal AI or Antiestrogen
Second line
if response
Steroidal AI
Third line
NoResponse
Chemotherapy
if response
Fourth line
Progestin
if response
Fifth line
Androgen
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Hormonal Therapies Metastatic Breast Cancer

• Tamoxifen 20 mg po daily
• Anastrozole 1 mg po daily, letrozole 2.5 mg or
  Exemestane 25 mg (post-menopausal)
• Fulvestrant (500 mg IM load then 250 mg IM)
• Megace 40 mg po 4 x daily
• Aminoglutethemide 250 mg po 4 x daily with
  hydrocortisone (post-menopausal)
• luteinizing hormone releasing analog 7.5 mg
  depot every 28 days (pre-menopausal)
• oophorectomy

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AFINITOR

• AFINITOR (everolimus) Tablets is a prescription
  medicine used to treat advanced hormone
  receptor-positive(ERPR) and (HER2 - )breast
  cancer, along with the medicine exemestane, in
  postmenopausal women who have already received
  certain other medicines for their cancer.

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Materials Methods

• 20 patients, with certain criteria,
• Docetaxel (TXT) Doxorubicine is the corner stone
  in the treatment of MBC, therefore, new
  combination (TXT Doxo) 4 cycles then 4 cycles
  of TXT as single agent, to evaluate the efficacy
  and safety of this combination.

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Herceptin (Trastuzumab) Study Design
Chemotherapy (AC or Paclitaxel) Herceptin
loading 4 mg/kg weekly 2 mg/kg
Chemotherapy Alone
Patients with untreated MBC HER2 overexpression
2 3
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Herceptin Time to Progression
1.0
0.8
p lt 0.001
Herceptin
Proportion Progression-Free
0.6
Control
0.4
0.2
0.0
0
5
10
15
20
25
Time to Progression (Months)
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Trastuzumab Pivotal Trial Efficacy Summary
Herceptin Herceptin
Herceptin AC AC Taxol Taxol CT CT Parameter
(n 143) (n 138) (n 92) (n 96) (n
235) (n 234) Median TTP (mo)
7.8 6.1 6.9 3.0 7.4 4.6p value
lt 0.001 lt
0.001 lt 0.001 Median
survival (mo) 26.8 21.4 22.1 18.4 25.1 20.3p
value 0.16
0.17 0.046
Substrata Overall
Slamon et al. N Engl J Med. 2001344783.
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Results

• The best management of MBC is done by dividing
  patients into 2 groups
• 1.Low risk group which treated by hormonal
  therapy.
• 2.Intermediate-High risk group which treated by
  chemotherapy.

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Discussions

• Trastuzumab (Herceptine) monoclonal antibodies is
  the treatment of choice for patients with MBC and
  Her/neu .
• Surgery and radiotherapy is used in MBC only for
  palliation.

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Tanks for Your Kindness Attention