Highlights in the Administration of Bosom Tumor Rome, May 25-26, 2007.


178 views
Uploaded on:
Category: Business / Finance
Description
Highlights in the Administration of Bosom Tumor Rome, May 25-26, 2007. CLINICAL CASE. Dott.ssa Simona Gildetti Cattedra di Oncologia Medica Università "G. D'Annunzio" Chieti-Pescara Direttore: Prof. Stefano Iacobelli. 48 years of age, female, pre-menopausal No comorbility .
Transcripts
Slide 1

Highlights in the Management of Breast Cancer Rome, May 25-26, 2007 CLINICAL CASE Dott.ssa Simona Gildetti Cattedra di Oncologia Medica Universitã  â€œG. D’Annunzio” Chieti-Pescara Direttore: Prof. Stefano Iacobelli

Slide 2

48 years of age, female, pre-menopausal No comorbility September 2005: Left bosom lumpectomy + axillary analyzation Ductal invading carcinoma, 2.4 cm, G3 ER=0% PR=0% HER2+++ PT2 PN0 M0

Slide 3

ADJUVANT TREATMENT Cardiac assessment at pattern Ecocardiography LVEF=66.3% October 2005 – February 2006: FEC100 q21 6 cycles

Slide 4

ADJUVANT TREATMENT (2) Radiotherapy (March 2006) April 2006: Cardiac assessment pre-Trastuzumab Ecocardiography: LVEF=64% Trastuzumab 6 mg/kg (8 mg/kg stacking measurements) q21 x 1 year

Slide 5

June 2006 (after 3 cycles of Trastuzumab) LVEF=52.5% 18% decrease in LVEF (asymptomatic patient) Continue Trastuzumab Therapy? YES NO

Slide 6

Herceptin Temporally Discontinued July 2006 (following 4 weeks of suspension) LVEF=64.5% Reintroduction of Trastuzumab Therapy Cardiac capacity firmly assessed

Slide 7

August 2006 (after two different cycles of T): LVEF=50% 22% diminishment (asymptomatic patient) What is the more proper administration?

Slide 8

Continue Trastuzumab Therapy? YES NO

Slide 9

Reintroduce Trastuzumab just when LVEF is satisfactorily re-built up (i.e. > 55%)? YES NO

Slide 10

Discontinue Trastuzumab conclusively? YES NO

Slide 11

Pooling of NSABP-B31 NCCTG N9831 N=3351 Med f-up=2y Four noteworthy adjuvant trials have demonstrated that Trastuzumab diminishes the danger of repeat No Trast FinHER BCIRG006 HERA HR N=3222 Med f-up= 1,5y N=3387 Med f-up=1y TH or VH FEC TCH Chemo H AC TH AC P H 0.61 0.54 0.49 0.48 0.46 T=docetaxel C=cisplatin or carboplatin P=paclitaxel Chemo= generally anthracyclines Timing of Trastuzumab start Upfront After 4 months After 8 months

Slide 12

The rate of serious Trastuzumab cardiovascular related occasions in adjuvant trials stays inside adequate levels Summary of heart security with Trastuzumab in right on time bosom malignancy Baselga et al, The Oncologist 2006;11 (suppl 1)

Slide 13

ADJUVANT TRASTUZUMAB TRIALS COMPARISON OF CARDIOTOXICITY RISKS

Slide 14

Observational study Over a 4-year period, 38 patients with HER2/neu-positive bosom disease, who have gotten anthracycline before Trastuzumab treatment, were alluded for suspected Trastuzumab-related cardiotoxicity The mean LVEF pre-Trastuzumab was 0.61 ± 0.13 After 4.5 months (middle) of Trastuzumab treatment, the mean LVEF diminished to 0.43 ±0.16 …

Slide 15

…after withdrawal of Trastuzumab, the LVEF expanded to 0.56 ± 0.11, with an interim to recuperation of 1.5 months The middle span of reintroduced Trastuzumab treatment was 8.4 months Michael S. Ewer; J Clin Oncol 23; 2005

Slide 16

In summary… The Trastuzumab-related cardiotoxicity in patients with HER2+ bosom malignancy is by all accounts to a great extent reversible when trastuzumab is pulled back Standard treatment for LV brokenness and CHF may hurry this recuperation, permitting Trastuzumab to be reitroduced Thus, reintroducing Trastuzumab may be suitable for a few people who already have encountered Trastuzumab-related heart brokenness

Slide 17

Cardiac wellbeing rules for the adjuvant utilization of Trastuzumab [Herceptin] in HER2-constructive early bosom disease Ewer MS.; St. Gallen Conference, 2007 Management of asymptomatic abatements in LVEF amid adjuvant Trastuzumab ?

Slide 18

Cardiac security rules for the adjuvant utilization of Trastuzumab [Herceptin] in HER2-positive early bosom disease Management of symptomatic heart occasions amid adjuvant Trastzumab ? Ewer MS.; St. Gallen Conference, 2007

Slide 19

August 2006 Trastuzumab has been authoritatively ceased after the second lessening of LVEF Patient has been checked on by a cardiologist: No treatment for heart disappointment Patient in subsequent LVEF=61.5% March 2007: Ecocardiography

Slide 20

Further catch up of the adjuvant trials will expand our insight into the nature and reversibility of cardiovascular occasions connected with Trastuzumab utilization. These information will help to clear up the danger/advantage proportion on an indivi

Recommended
View more...