Adjuvant Therapy - St. Gallen 2001 - CT = Chemotherapie; Tam = Tamoxifen ER and/or PgR positive Nodal positive CT + Tam Tam ER and PgR negative Chemotherapy Nodal negative Average/High Tam Tam+CT Minimal/Low Tam none
Risk Categories for node (-) breast cancer J Clin Oncol 21:3357, 2003
8th St Gallen breast consensus meeting 2003 J Clin Oncol 21:3357, 2003
St. Gallen March 2003 N negative(average risk), N positive Pre– and Post ER and PR negative Chemotherapy Premenopausal Er and/or PR positive OS* + Tam or Chemo Tam or OS* + Tam +/- Chemo Postmenopausal Er and/or PR positive Tam or Chem Tam OS* OS* = Ovarien Suppression: GnRH (Zoladex), 2 to 5 years. Oophorectomy
Aromatase inhibition within the breast tumour cell ANDROGENS OESTROGENS P-450 Aromatase + NADPH-cytochrome P-450 reductase (Testosterone, androstenedione, 16-OH-testosterone) (Oestradiol, oestrone) Aromatase Inhibitors tumourgrowth
Sites of peripheral aromatisation BreasttumourMuscleFatLiver
Femara = Letrozole Non-steroidal Steroidal Arimidex = Anastrozol e CH 3 H3CH3C NCCN N N N H3CH3CCH 3 Chemical Structures of Newer Aromatase Inhibitors NC CN N N N Aromasin = Exemestane O CH 2 O CH 3
Premenopausal ER (+) –Hormonal treatment Ovarian function suppression/ablation –Surgical oophorectomy –Radiation induced ovarian ablation –GnRH analog –Chemotherapy
Premenopausal Ovarian function suppression/ablation –Equivalent to chemothx Tamoxifen –Effective for ER(+) Ovarian function supression + tamoxifen –At least as effective as chemothx –Goserelin (2-3 yrs) + tamoxifne (5 yrs)
Premenopausal Ovarian function suppression + AI : ? Endocrine agent + trastuzumab : ? GnRH analog + tamoxifen –In HER-2 overexpression
Adjuvant chemotherapy CMF vs AC Taxane Sequential single agents vs simultaneous combination Dose-dense regimen Optimal timing –Postoperative vs preoperative
9 th St. Gallen International Consensus Conference on Primary Therapy of Early Breast 2005 Aromatase inhibitor –Postmenopausal, endocrine responsive –Optimal use ? Taxane –Not conclusive ? Dose dense regimen –Not conclusive ? Trastuzmab –No data are available yet.
Case 58 세 여자 좌측 유방암으로 유방보존술 및 액와림프절절제술 시행함. 수술병리조직소견은 다음과 같음. – 종양크기 : 1.5x1.2cm – 액와림프절 : 0/12 –ER(+), PR(+) –HER-2: +3
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