AdvancedBreastLesionTreatment

DidierBOURGEOIS,MDSurgeryTeamofHenriHartmannBreastInsAtute

Neuilly-Sur-Seine-FRANCE

DefiniAonl  StadeIIIUICC

l  StadeIIIAl  T0,1,2N2M0l  T3N1,2M0

l  StadeIIIBouT4N0,1,2M0l  StadeIIIC

l  TxN3M0

l  InflammatorydeseaseT4dwometastasis

IntroducAonl  5%metastaAc

l  20–30%chanceofdevelopingmetastasis

l  MedianSurvival:30–36month

l  5-yearSurvival:5–10%

Incidencel  Geographicvariability

l  RareinNorthAmerica&inEurope

l  Buthighprevalenceinunderdevelopedcountry

Incidence&Clinicalappearancel  Inwelldevelopedcountry:oldwomancancer

l  InUnderdevelopedcountry:youngwomancancer

l  Wideheterogeneityl  Tumoralphenotypel  MetastasisevoluAvity

l  Notthesametreatment

l  NotthesamepronosAc

PronosAcFactors1l  PaAent-relatedFactors

l  Agel  Comorbidity

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

PronosAcFactors2l  Tumoral-relatedFactors

l  HormonalReceptorsl  OverexpressionHER2

PredictorsofResponsel  HormonalReceptors

l  OverexpressionHER2

l  ModificaAonsofthesefactorsduringtreatmentl  Biopsy+++helptoadjusttreatment

RaAonalityl  LocaltreatmentwithsurgeryandradiotherapyisnoteffecAve

l  Generaltreatmentwithchemotherapyorhormonotherapy

l  TobringthepaAenttothesurgery

Whatkindofgeneraltreatment?l  Foragoodlocalresponse,itdependsofthetumoralphenotype

l  Hormonalreceptorsl  HER2overexpressedl  MitosisindexwithKI67

l  IldependsoftheageofthepaAent,menopausalstatusandherwellness

LocalyAdvancedCancerofoldwomanl  OncogeriatricconsultaAon

l  DiscussionwithfamilyandpaAent

l  ChemotherapyiftriplenegaAv

l  HormonaltreatmentwithfirstorsecondgeneraAonofinhibitorofaromatasel  Anastrozole,letrozole,exemestanel  Tamoxifenel  Fulvestrant

FailureofHormonotherapyl  Everolimus(Afinitor®)withexemestane

ChemotherapyopAonl  Rapidlyprogressivedesease

l  Lowprobabilityofresponseofhormonotherapy

l  Youngwoman

ChemotherapyopAonl  Docetaxel+Capecitabine

l  Taxane+Gemcitabine

l  5-FU+Navelbine(Fun)

l  HER2+Tumors:CT+trastuzumabl  Taxanel  Capecitabinel  Vinorelbine

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

LocalyAdvancedCancerofyoungWomanl  Chemotherapy

l  WithTaxansandcyclophosphamideTACl  Withtranstuzumab

l  80%ofgoodandverygoodrespons

l  Surgicaltreatmentacceptedwithmastectomy

LocalyAdvancedCancerofyoungWomanl  Recurrenceofcancer:2ndlineofchemotherapy

l  Dependsondelayofrecurrencel  >/<2years

l  Maintenancetreatmentwithbevacizumab(opAonnal)

l  DuraAonoftreatment?l  DeseaseevoluAonl  Maximalaccumulateddosel  CumulaAvtoxicityl  PaAentchoice

HAKSexperience-Cambodia