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approach
Surgical option is the mainstay of the treatment of EBC1
Breast-conserving surgery (lumpectomy, or segmented
Surgical option
Breast-Conserving Surgery (BCS) has become the standard
Lnn. must not be fixed to other lymph nodes and to surrounding tissue
mastectomy.1
Systemic Treatment
1. Neo adjuvant/ adjuvant: regimens for
raloxifene
Aromatase inhibitors: anastrozole, letrozole, and
exemestane
Progestin, androgens hormone, LHRH agonist
bevacizumab, pertuzumab.
1. NCCN version 3.2014
Preffered regimens:
Other regimens:
Dose dense AC (doxorubicin/cyclophosphamide) every 2 weeks
FAC (fluorouracil/doxorubicin/cyclophosphamide) or FEC
(cyclophosphamide/epirubicin/fluorouracil) every 3 weeks
CMF (cyclophosphamide/ methotrexate/fluorouracil)
AC followed by docetaxel every 3 weeks
AC followed by weekly paclitaxel
EC (epirubicin/cyclophosphamide) every 3 weeks
FAC/FEC followed by weekly docetaxel or paclitaxel
TAC (docetaxel/doxorubicin/cyclophosphamide) , etc
NCCN Guidelines Version 3.2014
Preferred Regimen:
AC followed by T + trastuzumab pertuzumab
(doxorubicin/cyclophosphamide followed by paclitaxel plus
trastuzumab, various schedule)
TCH (docetaxel, carboplatin, trastuzumab) pertuzumab
Etc
Other Regimens:
Targeted Terapi
Endocrine Therapy (ET):
Targeted Terapi
Anti HER2 (+)
Indicated for adjuvant treatment of HER2 positive BC
Conclusions from BCIRG 006 trial:1
Trastuzumab provides a similar and significant advantage for both
Normal (1x)
~ 25,000-50,000 HER2
receptors
Overexpressed
HER2 (10-100x)
up to ~ 2,000,000
HER2 receptors
HER2 oncoprotein
overexpression
Shortened survival
Median Survival From First Diagnosis
HER2 overexpressing
3 yrs
HER2 normal
6-7 yrs
Slamon DJ, et al. Science. 1987;235:177-182. Slamon DJ,
et al. Science. 1989;244:707-712.
Adjuvant
Tumours 1 cm
ESMO1,2
Trastuzumab should be
added to neoadjuvant
chemotherapy in patients
with HER2-positive
tumours
NCCN3
Tumours 1 cm
St. Gallen4
Duration
1 year of
trastuzumab
1 year of
trastuzumab
1 year of
trastuzumab
* Please note that international guidelines may not be in line with current national guidelines.
M770012
H0648g1
Trastuzumab + chemotherapy (n=235)
Chemotherapy (n=234)
80
60
40
20
1.0
Survival probability
Survival probability
100
0.8
p=0.0325
0.6
0.4
0.2
25.1
20.3
extends life
22.7
31.2
0
0
15
25
35
Time (months)
45
10 15 20 25 30 35 40 45
50
Time (months)
Second-line
Trastuzumab emtansine
(T-DM1) 2,3
Lapatinib + capecitabine13
Trastuzumab +
capecitabine2
Trastuzumab
chemotherapy13
Trastuzumab + lapatinib13
Trastuzumab +
taxane/second-line
chemotherapy / cytotoxic
agents3
AI + anti-HER2 therapy3
Trastuzumab13
Third-line
Trastuzumab and/or
lapatinib combinations1,3
* Please note: Published International guidelines may not be in line with current national guidelines and approved labels
AI, aromatase inhibitor
1. Cardoso et al. Ann Oncol 2012; 23:vii11-vii19;
2. http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf (v1_2014)
3. http://www.ago-online.de/de/start/
Summary
Management of BC involves more than one approach.
Thank You